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Co-hosts Louise Campbell and Roger Green are joined by friend of the podcast, Naim Alkhouri, and new guest, Professor James O’Beirne, to discuss liver disease in Australia and developing improved models for patient identification and risk stratification.

James , a Consultant Hepatologist at the Sunshine Coast University Hospital, shares his professional background and introduces events which lead to the LOCATE-NAFLD study. After Australia became the first country to allow access to direct-acting antiviral agents for HCV in 2016, there was the strong need to determine which patients were cirrhotic. With relatively unprepared primary care providers, specialist and hospital care were inundated with referrals. In response, James contributed to the inception of a mobile FibroScan program to deliver scans, assessments and treatment recommendations to community health clinics and GP practices. The program was very successful and it was decided that data should be published followed by an economic analysis to demonstrate how this was an effective model of democratizing access to risk stratification. As it was later sought to be applied to different disease areas, the LOCATE-NAFLD project was born. James outlines the parameters which can be read in a succinct overview here:

The LOCATE-NAFLD study is a 1:1 parallel randomized trial to compare two alternative models of care for NAFLD (usual care versus LOCATE-NAFLD).

Usual care group

• Patients will attend a specialist hepatology clinic for their care.

LOCATE-NAFLD group

• Patients will be assessed by a specialist study nurse in the primary care setting, such as local general practice clinic.
• The specialist nurse will assess patients using mobile transient elastography, using a FibroScan machine.
• Scan results will be reviewed by the specialist nurse and hepatologist
• Patients with low levels of liver scarring will be referred back to their GP for care
• Patients with high levels of liver scarring will be followed up in secondary care hepatology clinics

Quality of life will be assessed for all patients at baseline and at 12-month follow-up via a questionnaire. The study will analyse intervention costs, hospital outpatient clinic utilization, hospital admissions, hospital costs and patient death data.

From here the conversation opens to comments from the other panelists and Naim commends that this effort is being studied in a randomized trial and goes on to ask questions around protocol. Louise discusses the impact conducting FibroScan has on mediating patient behavior and the potential reach this sort of model has as she considers empowering the likes of dieticians and other skilled practitioners. Roger introduces ideas around extrapolating these insights for use in countries outside of Australia and goes on to discuss clinical care pathways and what motivating frontline treaters looks like both in the absence and presence of approved medications. Naim shares his experiences venturing into Arizona with mobile FibroScan consultations, mostly focused on patients with type 2 diabetes, obesity and other risk factors. The second half of the conversation touches more on economic analysis and the impact of improving technology on delivering more consistent results for scans. For final question, Roger prods James for what's next in this story and asks Louise and Naim what about this conversation influences their work and respective locations today.

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