BACKGROUND:In 2022, South Africa had an estimated hepatitis B prevalence of 4·7-6·0%. In an effort to eliminate viral hepatitis as a public health threat, a targeted (ie, selective) hepatitis B birth-dose vaccination (HepB-BD) policy was introduced in 2023. Under this policy, only infants born to mothers with confirmed hepatitis B positivity are eligible for HepB-BD, which is given in addition to peripartum antiviral prophylaxis (PAP) for mothers from the second or third trimester of pregnancy. This policy differs from the WHO recommendation that all newborns should receive a HepB-BD vaccine (ie, a universal HepB-BD policy). We aimed to assess comparative costs and benefits of this and alternate policies in South Africa. METHODS:A validated model of transmission, disease progression, and mortality was used to simulate the ongoing hepatitis B epidemic in South Africa. We projected outcomes from the current South African policy (ie, selective PAP plus selective HepB-BD), a universal HepB-BD-only policy, and the WHO-endorsed selective PAP plus universal HepB-BD policy. Health and economic impacts were compared with a baseline of no HepB-BD coverage, over a 2025-100 time horizon. Costs were reported in consumer price index-adjusted 2024 ZAR and outcomes discounted at 3% per annum. FINDINGS:The current South African HepB-BD policy required fewer vaccinations per outcome averted, with the number needed to vaccinate per vertically acquired chronic hepatitis B infection averted found to be six (95% uncertainty interval 3-15), compared with 462 (223-1479) under a universal HepB-BD-only policy or 77 (38-240) under a selective PAP plus universal HepB-BD policy. Despite incurring the greatest programmatic costs, a selective PAP plus universal HepB-BD policy averted the greatest disease burden and was modelled to be the most cost-effective option at a willingness-to-pay threshold of 0·5 × per-capita gross domestic product (ZAR 57 281). INTERPRETATION:Our findings support implementation of a universal HepB-BD policy alongside South Africa's current hepatitis B viral transmission elimination efforts. FUNDING:Vaccine Impact Modelling Consortium.

Hepatitis C virus (HCV) diagnosis in low- and middle-income countries (LMICs) relies on costly and technically demanding centralized laboratory services. This review aims to synthesize evidence on Point-of-Care (POC) HCV testing in LMICs to inform scale-up for HCV elimination. We searched Medline, Embase, PsycINFO, and the Cochrane Library for studies on decentralized POC HCV testing in LMICs between 2010 and 2022. Two reviewers independently conducted eligibility assessment and full text review. Testing uptake and linkage data were extracted using Excel, then descriptively synthesized to identify common patterns. Our systematic review identified 2018 reports of which 1603 underwent title and abstract screening. Among them, 58 met the eligibility criteria, but only 20 reports proceeded to data extraction. Of these, 16 examined feasibility and effectiveness, showing high testing uptake and linkage to care. In the 11 reports where services provided onsite testing and/or treatment, uptake of testing and/or treatment exceeded 90%. Four studies assessed HCV self-testing among high-risk populations and showed high acceptability (91%-99%). Studies evaluating oral-based self-testing among high-risk populations reported higher recommendation rates (94%-99%) compared to that of blood-based testing (86.1%). Our findings suggest that decentralized HCV testing and care models likely improve testing uptake and treatment success in LMICs, given the high rates of retention in care and cure.

BACKGROUND:People prescribed opioid agonist therapy (OAT) are a key population for hepatitis C virus (HCV) elimination. Health service engagement associated with OAT provision may facilitate hepatitis C testing and treatment. We aimed to quantify the HCV care cascade among people receiving OAT in Australia. METHODS:We extracted linked data from individuals attending any of 58 clinics participating in the ACCESS national sentinel surveillance network of primary care and sexual health clinics from 1 January 2016 to 31 December 2023. Outcomes included evidence of any HCV test (antibody or RNA) or direct-acting antiviral (DAA) prescription at an ACCESS clinic after their first OAT prescription. RNA positive individuals were inferred antibody positive; individuals with a DAA prescription were inferred RNA and antibody positive. We determined the number of individuals at each stage of the following cascade by the end of the study period: (1) positive antibody, (2) positive RNA, and (3) DAA prescription. RESULTS:Among 15 382 individuals prescribed OAT, 44% (6817) had an HCV antibody or RNA test after their first OAT prescription. Of these, 64% (4368/6817) were antibody positive by the end of the study period. Of these, 67% (2911/4368) were RNA positive, and of those, 69% (2007/2911) were prescribed DAAs. CONCLUSIONS:A high proportion of people prescribed OAT were not engaged in care by their OAT provider or across ACCESS network clinics, but when diagnosed, rates of treatment were high. Given high HCV antibody and RNA prevalence, integrating HCV care into regular OAT care should be a priority for HCV elimination in Australia.

BACKGROUND AND OBJECTIVES:Healthcare utilisation was disrupted by the COVID-19 pandemic, adversely affecting population health. This study investigated healthcare access and utilisation during the COVID-19 pandemic. METHOD:The Optimise Study recruited Victorian adults during September 2020-December 2021. This cross-sectional study examined difficulty accessing healthcare, changes experienced in healthcare utilisation and concerns related to healthcare. RESULTS:Among 779 participants, one-fifth had difficulty accessing healthcare. Participants with chronic illness/es (adjusted odds ratio [aOR]: 2.15, 95% confidence interval [CI]: 1.40-3.30) or earning $1-49,999 per year (aOR: 2.31, 95%CI: 1.14-4.93) or speaking a language other than English at home (aOR: 2.70, 95%CI: 1.38-5.30) had an increased odds of reporting difficulty accessing healthcare. Among 779 participants, the two biggest concerns were delaying or avoiding seeking care (24.4%) and anxiety associated with attending services because of the COVID-19 pandemic (24.0%). DISCUSSION:Future pandemic planning should consider strategies to ensure clear and timely communication with people about how to continue accessing healthcare in emergency situations.

The community corrections population in Australia shares similar risk factors for hepatitis C virus (HCV) infection with people incarcerated in prisons, but without access to prison-based testing and treatment. While hepatitis C testing and treatment programs are well established in prison settings in Australia, little attention has been paid to equivalent programs in community corrections settings. C No More is a study to evaluate the acceptability and efficacy of a novel, mobile, nurse and peer-led model of hepatitis C testing and treatment at community corrections offices in Melbourne, Australia. A clinically equipped van staffed by a hepatitis clinical nurse consultant and peer workers will spend scheduled periods parked adjacent to four community corrections offices in metropolitan Melbourne. People attending community corrections offices will be opportunistically approached by a peer worker and invited to undertake hepatitis C testing. Other individuals in the vicinity of the community corrections office may also be invited to access the service. Following enrolment, study staff will conduct hepatitis C point-of-care testing and clinical assessments in the van. Point-of-care HCV antibody tests will be used for initial screening, and where positive, point-of-care HCV RNA tests performed. Participants with self-reported HCV antibody will be reflexed to RNA testing. RNA positive participants will be assessed for rapid treatment initiation, and prescribed DAA treatment. Treatment dispensation will occur from the van or through a community pharmacy. Participants will be monitored throughout treatment and offered point-of-care HCV RNA testing four or more weeks after treatment completion to confirm sustained virological response (SVR-4 +). The primary outcomes of this study are the proportion of those who are HCV RNA positive who initiate DAA treatment and the acceptability of this model of care. This study will provide evidence of acceptability, feasibility, and clinical effectiveness of a nurse and peer-led, mobile model of hepatitis C care at community corrections offices. The outcomes of this study will inform other models of care aiming to provide hepatitis C testing and treatment to individuals involved in the criminal justice system. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623001043628). Date of registration: 27/09/2023.

Introduction Despite the availability of curative treatments, hepatitis C diagnosis and treatment coverage is suboptimal globally with few countries on track to achieve the WHO’s 2030 elimination targets. In 2022, an estimated 50 million people were living with hepatitis C, with 1 million new infections annually. Most people living with hepatitis C reside in low- and middle-income countries, and people who inject drugs are disproportionately affected by hepatitis C.Continuing simplification of diagnostic pathways and treatment care models is required to improve linkage to care and reduce costs associated with hepatitis C treatment and cure.Methods and analysis This study is a multi-country non-randomised, quasi-experimental, prospective comparative two-arm trial. It aims to assess the feasibility of implementation, retention in hepatitis C care and achievement of cure and cost-effectiveness outcomes, comparing two simplified hepatitis C testing and treatment pathways.Arm 1 is a standard simplified test and treat model of care following global guidance, and arm 2 is an innovative rapid, same-day treatment initiation model of care using a presumptive treatment approach based on shortened read-time of the point-of-care OraQuick hepatitis C antibody test result. Secondary outcomes include assessing the accuracy of the OraQuick hepatitis C antibody test in predicting viraemia and the acceptability of each pathway.This study will be implemented in Armenia, Georgia and Tanzania. Treatment-naïve people who inject drugs aged over 18 years in each country will be eligible for enrolment.Recruitment commenced in October 2024 in Armenia, June 2025 in Georgia and August 2025 in Tanzania and is anticipated to close by December 2026.Ethics and dissemination This trial has been reviewed by WHO Ethics Review Committee (ERC), Alfred Hospital Ethics Committee (Australia) and local country ERCs. Alongside journal publications and conferences, the results from this study will be disseminated through summary reports and workshops with key stakeholders and with communities of people affected by HCV through relevant organisations/networks, including the global Community Advisory Board (CAB). The study results will inform national scale-up of simplified care models and inform potential pathways for further simplification of care models, including the potential for one-step diagnostic pathways and same-day treatment in particular scenarios for the three study countries, and other low- and middle-income countries globally.Trial registration number NCT06159504.

Throughout COVID-19, public health responses lacked engagement with multicultural communities. Collaborating with multicultural communities is essential to understand priorities and create culturally appropriate solutions. Our participatory study aimed to identify the public health priorities of the Muslim community, explore potential solutions, develop resources and monitor their uptake. In 2022, we formed a research-community partnership with the Burnet Institute, Islamic Museum of Australia, Australian Multicultural Foundation and Your Community Health. Together, we co-developed a cross-sectional survey to identify the priorities of a Muslim community in Melbourne, Australia following the COVID-19 pandemic. Participants (n = 57) were recruited through the networks of three bilingual project officers and Preston Mosque. Participants reported what they needed to feel safe, supported and healthy, ranking 15 items. Through open-ended responses, participants could elaborate on their support needs. We then conducted two participatory and interactive workshops with eight Muslim community members to explore potential solutions to identified needs. Data were synthesised in Miro and validated through partner meetings. Together, we drew on results to develop a series of resources. We monitored resource uptake through partner interviews (n = 4), a document review and descriptive statistics. Survey results indicated that participants most needed jobs (60

Objective:The prevalence of chronic hepatitis B in Vanuatu is high, at approximately 9%. While immunization has been available for infants since 1989, subsets of the adult population remain susceptible, including health-care workers. Prior to a planned roll-out of hepatitis B vaccination for health-care workers, we conducted a knowledge, attitudes and practices survey to inform education programmes aimed at promoting vaccine uptake. Methods:Clinical and non-clinical health-care professionals at risk of occupational exposure to hepatitis B were invited to complete an online survey from April to June 2024. The survey sought information on hepatitis B knowledge
(10 questions), attitudes (6 questions) and clinical practices (3 questions), as well as participant demographics. Participant knowledge scores were calculated and potential associations with demographic factors explored using Fisher's exact test. Results:Most of the 50 respondents were female (73%) and worked in either hospitals or the Ministry of Health (82%). Knowledge was high, with a median score of 9 (range: 3-10); 21 participants scored 100%. The proportion of incorrect responses was highest for questions related to treatment availability and transmission risks. We found no evidence of associations between demographic factors and knowledge scores. Most participants believed that hepatitis B vaccines were useful (88%) and prevention and control measures would protect them from infection (96%). Discussion:Our survey revealed high levels of knowledge and generally positive attitudes towards people with hepatitis B and infection control practices. While our respondents are unlikely to be representative of all health-care workers in Vanuatu, findings offer useful insights into specific knowledge gaps that could be addressed in planned health-care worker education sessions ahead of the vaccination roll-out.

Background Chronic hepatitis B virus(HBV) remains a major cause of hepatocellular carcinoma(HCC) in Australia, despite the availability of effective, subsidised antiviral therapy. We aimed to describe the clinical characteristics, HBV care cascade and outcomes among people with HBV-related HCC in Victoria, Australia. Methods We conducted a multicentre cohort study of all incident HCC cases across eight tertiary health networks in Victoria, Australia. Cases were identified retrospectively(1 January 2018 to 31 October 2021) and prospectively(1 November 2021 to 31 October 2022). The primary outcome was the proportion of incident HCC attributable to HBV. Secondary outcomes included uptake of guideline-based antiviral therapy and surveillance and overall survival from HCC diagnosis. Multivariable logistic regression was used to identify factors associated with treatment and surveillance uptake. Results Among 1203 incident HCC cases, 219(18.2%) were HBV-related. Most patients were male (89%) and of Asian ethnicity(60%). While 61% were aged 56–75 years, 25% were 36–55 years. Cirrhosis was present in 141(64%), although 57(26%) were newly diagnosed with cirrhosis at HCC presentation. 121(60%) patients were eligible for antiviral therapy. Linkage to specialist care was associated with treatment uptake(adjusted OR 8.4, 95% CI 4.3–16.1; p<0.001). Surveillance enrolment at diagnosis was higher among HBV-related HCC compared with non-HBV HCC(48% vs 40%). Conclusion HBV remains a substantial contributor to HCC in Australia. Gaps in antiviral treatment and cirrhosis recognition persist, highlighting missed opportunities for prevention and early detection. Interventions to improve linkage to care and delivery of guideline-based HBV management are urgently needed.

BACKGROUND:In Australia, transgender people have largely been excluded from public health surveillance for HIV and other sexually transmissible infections (STIs). We aimed to provide a comprehensive overview of HIV and STIs among transgender people in Australia, including to investigate trends over time and risk factors. METHODS:A retrospective clinical cohort study was conducted using 10 years of health record data (between Jan 1, 2014, and Dec 31, 2023) from 87 health services across Australia. A primary transgender cohort and two comparative cisgender cohorts (gay and bisexual men, and heterosexual people) were established. Incidence was estimated using repeat testing, with the year fitted as an independent variable in Poisson regression while controlling for sociodemographic and behavioural characteristics. FINDINGS:The primary cohort comprised 7284 transgender people (4672 transgender women, 2213 transgender men, and 399 non-binary people); the comparative cisgender cohorts comprised 152 144 gay and bisexual men and 394 332 heterosexual people. Among transgender people, HIV incidence decreased by 93·9%, from 1·19 per 100 person-years to 0·07 per 100 person-years (incidence rate ratio [IRR] per year 0·72 [95% CI 0·66-0·79]). For transgender people, HIV incidence was highest among women (0·37 per 100 person-years) and lowest among men (0·20 per 100 person-years; IRR 0·54 [95% CI 0·29-0·99]). Transgender people overall had an HIV incidence comparable with cisgender gay and bisexual men (0·33 per 100 person-years and 0·29 per 100 person-years, respectively; adjusted IRR 0·87 [95% CI 0·70-1·08]), whereas HIV incidence was lower among cisgender heterosexual people (0·003 per 100 person-years; 0·01 [0·01-0·01]). Incidences of other STIs were generally stable among transgender people over time (33·73 per 100 person-years for chlamydia, 30·18 per 100 person-years for gonorrhoea, and 2·67 per 100 person-years for syphilis), with some distinctions by anatomical site. Among transgender people, HIV pre-exposure prophylaxis was negatively associated with incident HIV (adjusted IRR 0·40 [95% CI 0·19-0·88]) but positively associated with other STIs (1·38 [1·31-1·46]). INTERPRETATION:HIV incidence declined among transgender people in Australia, whereas other STIs were stable. To build on this success, HIV and STI policies, guidelines, interventions, and funding in Australia should more actively support transgender populations. FUNDING:Australian Department of Health & Aged Care and UNSW Health Systems Research.

Purpose:Natural disasters such as earthquakes, cyclones, and volcanic eruptions directly and indirectly impact health and wellbeing. This work aimed to understand how access to, and use of, peripartum health services were impacted following a large 7.3 magnitude earthquake in Vanuatu in the context of an ongoing field trial looking at the effectiveness of universal peripartum antiviral prophylaxis for pregnant women living with hepatitis B to prevent mother-to-child transmission. Methods:Participants were pregnant women enrolled in the intervention-arm of a field trial at sites in the earthquake-affected area. During routine monitoring calls, we asked additional questions about the impact of the earthquake on continued access to health services and continued use of daily hepatitis B antiviral prophylaxis with tenofovir disoproxil fumarate. Results:Seventeen participants of 26 women enrolled in the trial could be contacted and answered all questions from early-February to early-March 2025. Self-reported continued use of tenofovir disoproxil fumarate was high, with only two of 17 participants reporting interruptions to use in the weeks following the earthquake. Seven participants (41%) reported missing at least one routine antenatal or postnatal appointment in the three months following the earthquake. Conclusions:In natural disaster-prone settings, it is critical that field research take an adaptive approach that can adjust and respond to health emergencies. While natural disasters are inevitable, health systems must implement risk mitigation strategies to limit interruptions to routine health services to reduce negative short-, medium-, and long-term health impacts of natural disasters.

To examine adherence to COVID-19 public health measures among culturally and linguistically diverse (CALD) and low socio-economic status (SES) populations in Victoria using a unique longitudinal cohort. The Optimise Study was a mixed-methods longitudinal cohort and social networks study (September 2020 – December 2023) assessing the impact of COVID-19 and related public health measures in Victoria, Australia. We used a serial cross-sectional design to analyse adherence to public health recommendations, restrictions, and requirements. The study examines two 28-day periods during the COVID-19 pandemic in Victoria: April 23– May 20, 2021 (‘non-lockdown’), and September 13–October 10, 2021 (‘lockdown’). We explored adherence to three categories of COVID-19 public health measures — Recommendations (non-enforced, longer-term), Restrictions (mandated during lockdown periods), and Requirements (mandated, longer-term) — among participants who completed questionnaires during these periods. Participants were grouped as: 1) non-CALD high SES (did not meet CALD or low-SES criteria), 2) CALD, or 3) non-CALD low-SES. Primary outcomes were adherence to Recommendations, Restrictions, and Requirements during the two study periods. Of 782 participants recruited, 579 (75%) completed a survey or diary during at least one study period and were included in the analysis. Of these, 275 (47%) were in the ‘non-CALD high-SES’ group, 114 (20%) in the CALD group, and 190 (33%) in the ‘non-CALD low-SES’ group. Across all groups, risk-reduction behaviours increased during the lockdown. CALD participants showed higher adherence to some Recommendations and Restrictions compared to the other groups. Overall, 28% left home while awaiting a COVID-19 test result, commonly due to work. High adherence among CALD and ‘non-CALD low-SES’ groups suggest structural barriers, rather than behavioural non-compliance, contributed to higher COVID-19 impacts, highlighting the need for tailored support. During future public health emergencies, better supports are needed for individuals working outside of home to remain in isolation while awaiting a test result. What is already known about this subject? In Australia, priority populations such as culturally and linguistically diverse (CALD) and low socio-economic status (SES) groups experienced higher COVID-19 infection, mortality and a disproportionate impact from public health restrictions. What does this study add? CALD populations had an overall higher level of adherence to public health behavioural measures during both lockdown and non-lockdown periods compared to non-CALD populations. Over 25% of participants did not comply with stay-at-home requirements while awaiting a COVID-19 test result, largely due to work responsibilities. How might this impact on clinical practice? Pandemic preparedness efforts should focus on understanding the reasons for non-adherence with isolation requirements and considering tailored support during future pandemics to address the diverse

INTRODUCTION:In Australia, cross-sectional estimates suggest that over 95% of people with HIV are virally suppressed; however, these measures reflect only the most recent viral load. Sustained viral suppression (SVS) is essential for optimizing health and preventing transmission. This study describes SVS among people with HIV who are engaged in care in Australia and factors associated with SVS. METHODS:We analyzed national data from the ACCESS sentinel surveillance system. Eligible participants attended an ACCESS clinic in 2023, received continuous antiretroviral therapy (ART; ≥1 prescription per calendar year), and had at least two viral load tests in the preceding three years (median:6; IQR: 5-7). SVS was defined as all viral load results less than 200 copies/ml. Multivariable logistic regression identified factors associated with SVS. RESULTS:Of 6036 eligible participants (95% men; median age 54 years), 5751 (95.3%) achieved SVS, while 99.1% were suppressed based on their last test. Older age (adjusted odds ratio [aOR]: 1.01; 95% confidence interval (95% CI): 1.002-1.03), residence in more socioeconomically advantaged areas (aOR: 1.06; 1.01-1.12), and higher mean CD4 + cell count (aOR: 1.00; 1.001-1.002) were associated with higher odds of SVS. Receiving care at publicly funded sexual health/hospital-based clinics (aOR:0.64; 0.48-0.86), more diagnoses of gonorrhea (aOR: 0.81; 0.67-0.96) or infectious syphilis in the last three years (aOR: 0.85; 0.73-0.98), and co-infection with hepatitis C in the last 3 years (aOR: 0.56; 0.36-0.87) were associated with lower SVS. CONCLUSIONS:More than 95% of people with HIV receiving ART and engaged in ongoing care achieved SVS. Strengthened, person-centered support for groups with lower SVS may enhance clinical outcomes and sustain Australia's progress toward HIV elimination goals.

Background The COVID-19 pandemic exacerbated health disparities globally, with certain populations experiencing disproportionate disease burdens. In Australia, COVID-19 deaths occurred disproportionately among first-generation migrants. This study examined risk factors for COVID-19 infection in a Victorian cohort recruited from priority populations, including healthcare workers, people with chronic health conditions, and culturally and linguistically diverse (CALD) communities. Methods We conducted a cross-sectional analysis of participants from the Optimise longitudinal cohort study (September 2020–December 2023). The primary outcome was the self-reported count of confirmed COVID-19 infections (PCR or rapid antigen test positive) from December 2019 to December 2023. We used Poisson regression to examine associations between baseline sociodemographic characteristics and infection count, calculating unadjusted and adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Results Of 433 participants (median age 51 years, 75% female), 25% reported no infections, 48% reported one infection, and 27% reported two or more infections. In univariate analysis, CALD status (IRR=1.24,95%CI:1.02–1.50) and larger household size (2-5 people, IRR=1.71,95%CI:1.14-2.50) were associated with higher infection rates, while chronic health conditions (IRR=0.73, 95%CI:0.61–0.88) and older age (IRR=0.54, 95%CI:0.43–0.67) were associated with lower infection rates. In adjusted analysis, younger age (18-34 years vs ≥55 years: aIRR=0.63,95%CI:0.48–0.82) and medium household size (living alone vs 2-5 person household: aIRR=1.42, 95%CI:1.11–1.83) remained significant predictors. CALD status and socioeconomic status showed no independent association with infection risk after adjustment for household size and age. Conclusion COVID-19 infection risk in this Victorian cohort was driven by younger age and larger household size rather than CALD status or socioeconomic status, suggesting that housing density and age, rather than cultural or socioeconomic characteristics, determined infection patterns. Future pandemic preparedness should prioritise policies enabling safe quarantine and isolation for individuals in larger households and workplace protections and economic security for younger essential workers. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval for Optimise was provided by the Alfred Human Research Ethics Committee, Approval Number 333/20. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.

BACKGROUND:In 2022, an estimated 74,400 people in Australia were living with hepatitis C. Despite an initial rapid uptake of direct acting antiviral treatment after their approval for use in Australia in 2016, national hepatitis C testing and treatment rates have declined since 2019. In response, It's Your Right, a national health promotion campaign co-designed with and for people with lived-living experience of injecting drug use and/or hepatitis C, was implemented in all Australian states and territories in 2022. This article presents outcomes of the campaign. METHODS:A mixed methods evaluation was co-designed with peer workers from peer-led drug user organisations and community-based hepatitis organisations. Campaign outcomes included analysis of social marketing reach data, hepatitis C testing and treatment data, and client survey. RESULTS:It's Your Right demonstrated wide reach with >8.9 million people seeing the campaign. The campaign was memorable - 53 % of clients from the implementing organisations who were surveyed demonstrated unprompted campaign recall, while 72 % remembered the campaign when prompted. Implementing organisations documented 2595 conversations about hepatitis C with clients, conducted 1343 hepatitis C tests, referred 151 people for treatment, and utilised 1254 incentives to engage clients in hepatitis C care during the campaign period. Thirty-eight percent of survey participants spoke to a peer worker, and 31 % accessed testing, due to seeing the campaign. CONCLUSION:It's Your Right was highly valued by implementing organisations and reached people in the community who inject drugs. The campaign inspired people to seek out support from peer workers and take up hepatitis C testing.