ProfessorNicola Stephens

Project Total: $2,950,995; The Australian Pathogen Genomics Program (AusPathoGen) will transform infectious diseases surveillance and response in Australia. Capitalising on the successes of AusPathoGen 2021-25, which developed the secure and fitfor- purpose AusTrakka genomics surveillance platform; established national ethics for pathogen genomics research; democratised access to sequencing technology; harmonised bioinformatic analysis approaches; and collated and analysed comprehensive national foundational datasets for key pathogens AusPathoGen continuation into phase 2 will fully realise nationally integrated public health pathogen genomics surveillance, investigate application of genomics to respond to emerging infectious diseases threats, and enhance reach and impact of Australias advancements in this area. The program will establish genomics-informed surveillance, optimised through iterative evaluations of impacts to reduce the burden of infectious diseases. It will equip Australia with optimised genomic models for: future pandemic threats; combined wastewater and clinical genomics surveillance; One Health genomic surveillance; and data on the value to genomics surveillance for drug-resistant STIs. It will produce evidence-based frameworks for: genomics contributions to surveillance from clinical genomics; prioritisation and implementation timelines for national pathogen genomics surveillance; and enhance genomic literacy of public health end users in Australia. AusPathoGen is underpinned by a well-established national network of leading experts embedded in Australias public health system, collaborating with a world-leading multidisciplinary academic team, partnerships with policy makers and consumers, and industry. This academic team is ideal to deliver the program, with expertise in national, multidisciplinary, and collaborative end-user focused translational pathogen genomics research and are committed to reducing the impact of infectious disease in Australia. Funded by: Medical Research Future Fund - Grant - Genomics Health Futures Mission; University of Tasmania.

Project Total: $24,000; Improving sexual and reproductive health remains a global health priority and is reflected in the Sustainable Developments Goals agenda for 2030. Australia's Blood Borne Viruses and Sexually Transmissible Infections Research Strategy supports relevant research to reduce the incidence of BBV and STI in Australia. A major concern is that BBVs and STIs remain undiagnosed and untreated. A key strategy is to increase diagnoses of BBVs and STIs through wider testing. To explore the BBV (hepatitis C, hepatitis B, HIV) and STI (chlamydia, gonorrhea, syphilis) testing practices in Tasmania, this study will undertake data linkage of all BBV and STI tests conducted within Tasmanian laboratories from 1 January 2014 to 31 December 2023 to measure population levels of testing, retesting and test positivity, and report on any demographic and health services differences in testing trends. This study will also link BBV and STI testing data in women aged 15 to 44 years with the Tasmanian Perinatal Data Collection to identify any gaps in testing by area of residence, age, and socioeconomic indicators. The findings will enable targeted advice to healthcare providers to increase testing where it is required, as well as targeted messaging to at risk populations. The resultant increase in testing will lead to reduced mortality and morbidity relating to BBVs and STIs in Tasmania, minimise the personal and social impact of BBVs and STIs on the Tasmanian population, and increase the likelihood of meeting the targets to eliminate HIV, hepatitis C, and hepatitis B as a public health threat in Tasmania. This project will also result in equitable antenatal BBV and STI testing of pregnant women in Tasmania and will increase the likelihood of all pregnant women in Tasmania being tested and treated for syphilis, thereby increasing the likelihood of congenital syphilis being eliminated in the Tasmanian population. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($24,000); University of Tasmania.

Project Total: $750,738; Chronic hepatitis B (CHB) is endemic across Indigenous communities in the Northern Territory (NT), with prevalence between 2-5%. Of this group, up to 25% will die from decompensated cirrhosis or liver cancer without care and treatment. In turn, liver disease is the third leading factor contributing to the gap in life expectancy between Indigenous and non-Indigenous Australians. In 2017 the NHMRC funded the Hep B PAST Partnership Project (GNT1151837), which aims to eliminate CHB from NT Indigenous Australians. This is being achieved through two mechanisms: improvement of CHB health literacy amongst participating Indigenous communities and healthcare providers; and transition of CHB care to a primary healthcare based, co-ordinated chronic disease model supported by the establishment of a CHB clinical register. The preliminary results of the Hep B PAST Project have demonstrated a highly effective model of care to increase rates of CHB diagnosis, treatment and community education. The Hep B PAST Project will be completed in mid-2023. To successfully eliminate hepatitis B, it is now critically important to transition this care model Territory-wide. Health economic evidence is now required by government to support this. We have developed five studies to generate this evidence: 1: Quantify costs of the Hep B PAST model of care and the status quo approach to CHB care; 2: Quantify quality of life/health state utility values for hepatitis B health states; 3. Develop and validate a health economic disease simulation model for hepatitis B for Indigenous communities; 4: Project clinical outcomes of the Hep B PAST model of care and the status quo up to 2035; 5: Assess the cost-effectiveness of introducing the Hep B PAST model of care as standard practice across the NT. We will develop the first Indigenous-specific health economic model that will be made available to support rapid, robust evaluations to introduce Hep B PAST into other states/territories. Funded by: National Health & Medical Research CouncilNational Health & Medical Research Council - Grant-Ideas ($1,501,476); University of Tasmania.

Project Total: $11,025; The burden of chronic hepatitis B (CHB) and chronic hepatitis C (CHC) in Australia is increasing, with an estimated 450,000 people living with chronic viral hepatitis, representing 2% of the population (1, 2). Viral hepatitis is the leading cause of primary liver cancer, which is now the fastest increasing cause of cancer death of Australians (3-6). Tasmania has fallen behind all other states and territories in meeting targets set out in national strategies. The National Hepatitis B Strategy1 targets for 2022 include 80% of people living with CHB will be diagnosed and 50% will be engaged in care. In 2020 (latest data available), 53% of Tasmanians had been diagnosed, and just 17% were receiving care2. For CHC, approximately 1% of the Tasmanian population is estimated to be living with this condition, however only 47% have received curative treatment2. The current National Hepatitis C Strategy3 has set the target of 65% of people having received treatment by 2022. The World Health Organization will be publishing updated CHB and CHC targets in the coming months. Based on these, the Australian Department of Health will set new targets for 2023-2030. In this context, it is timely for increased focus on viral hepatitis in Tasmania. Funded by: Donation via Menzies Institute for Medical Research - Donation ($11,025); University of Tasmania.

Project Total: $9,999,499; This project will develop, test and implement a new national infectious diseases and antimicrobial resistance pathogen genomics surveillance and control system, to improve the quality of public health infectious diseases control for the Australian population. Funded by: Medical Research Future Fund - Grant-Genomics Health Futures Mission Pathogens; University of Tasmania.