Hepatitis C crept up slowly on Dennis Maby, attacking his liver over two decades, before it came at him hard.
"I started to feel very fatigued, very tired," said Mr Maby, who believes he was infected with hepatitis C when he injected drugs in the 1980s.
He was so ill in 2019 he received a liver transplant but his condition worsened soon after.
"One of the arteries supplying blood to the liver became greatly infected, and I needed a graft of that artery … I had anaphylactic shocks to some of the medications they were administering to me," he told 7.30.
"I remember going down to the theatre in early March. I remember waking up in late May. So it was quite a long time I was in ICU and in an induced coma.
"A couple of times they called my wife, Benita, and told her that I may not make it through."
Fewer Australians should now have to experience the agony the couple went through, because there is now a reliable cure for hepatitis C, called direct acting antivirals (DAAs).
"The cure is amazing," Professor Margaret Hellard from the Burnet Institute said.
"It's one of the most extraordinary medical breakthroughs of the last couple of decades."
But there is a problem.
While around 100,000 Australians have now been cured, around 70,000 people with hepatitis C have not been treated, including an estimated 20,000 Indigenous Australians.
The challenge is finding and treating those 70,000 people, many of whom don't know they have the virus.
The number of people treated with DAAs annually has fallen from 33,202 people in 2016 to 5,202 people in 2022 and 5,426 people last year.
The rate of new infections is considerably higher. Last year 13,222 new hepatitis C infections were detected.
"We're at a critical juncture where if treatment uptake doesn't increase, we're going to struggle to meet our elimination targets," Professor Hellard said.
"We know we need to get enough people treated so that there's hardly anybody left with hepatitis C, and that means the number of new infections falls because you don't get transmission."
Cure in a Kombi
In inner Brisbane, Dr Joss O'Loan and registered nurse Mim O'Flynn are on the front line, finding and treating people with hepatitis C.
Their Kombi Clinic operates out of a repurposed van, which carries equipment that can detect the virus within an hour, and Dr O'Loan can prescribe DAA treatment on the spot.
"We can cure it," Ms O'Flynn said.
"One pill, once a day, for 12 weeks."
A previous treatment with interferon cleared the virus in just 50 per cent of patients but also caused debilitating side effects.
DAAs have a 97 per cent success rate with almost no health impacts.
"The whole point of the Kombi Clinic, and the reason we were set up, was this notion of hard to reach patients," Dr O'Loan said.
"We sort of flipped that on the head and said, 'It's not the patients that are hard to reach, it's often the clinics that are hard to reach'.
"So we take the clinic to where patients are going to go."
7.30 visited the Kombi Clinic as it set up on trestle tables at Brisbane's Emmanuel City Mission. Over several hours the clinic team tested a dozen people who may not have ordinarily visited a GP's office.
"Even the first step of going to see a GP isn't easy," Dr O'Loan said.
"Stigma is often a big thing, to have a conversation with someone to say, 'hey, I'm injecting drugs, I'm at risk of hep C, can you screen me?' That's a massive barrier for a lot of patients."
Esha Leyden received DAA treatment and is now clear of hepatitis C. She tests at-risk people and helps them seek treatment and is now helping Kombi Clinic staff and says fear plays a factor in people not getting tested.
"[People are] scared because of the old treatment, they're scared because they've got no veins and they're really embarrassed to go and get blood taken, and they're scared of the health care system," she said.
The prison problem
The Kombi Clinic also visits Queensland's prisons.
Rampant hepatitis C in jails is one key reason why the virus is not being eliminated in Australia. Prisoners pick up the virus by sharing needles for drugs and tattoos, and it spreads in the community once they're released.
"I was treating [people] in prisons just last month, and the amount of re-infections I see are staggering," Dr O'Loan said.
"Around 60 to 70 per cent of the people I treat are re-infections. Four, five, six times, eight times, I'm treating [them] for hepatitis C."
Australian prisons do not have needle and syringe exchange programs.
"I understand that in prisons, you could have an argument about, 'What are drugs doing in prisons?' Professor Hellard said.
"But we know that drugs are in prison. We know that injecting occurs in prisons, so why not provide appropriate harm reduction and care for people?"
She said it was possible to eliminate hepatitis C without needle exchanges in prisons "but it's like being in a fight with one arm tied behind your back".
"It to me makes no sense that we don't have an evidence-based approach to health in all sectors of the community."
Tackling stigma
The virus also disproportionately affects Indigenous Australians. Aboriginal people account for 16 per cent of those with hepatitis C, despite comprising just three per cent of the nation's population.
At Perth's Deen Clinic, Donna Garcia helps convince other Indigenous people to get tested and treated.
She'll combat stigma about the virus by reminding people that there are other ways to contract hepatitis C other than through injecting drug use.
"If I go and talk with young fellas, I won't talk about injecting drugs, I'll talk about backyard tattoos. As you can see, I'm covered in them," she said laughing.
She says the long, slow progression of liver damage also acts as a barrier to treatment.
"If you tell them, 'look, it mightn't affect you for 20 years, but if you drink alcohol, inject drugs, eat fatty foods, you're halving your time. So best to get on top of it now, and there is a cure – a tablet a day.'"
Mr Maby eventually recovered from his surgery complications and is now clear of hepatitis C through the DAA treatment.
He's enjoying retirement and urges anyone who thinks they might have the virus to get treated as soon as possible.
"Get tested, because you can find out early enough before it starts to do any damage," he said.
"It took some 20 years for it to show for me, but then it was starting to be too late to almost do anything about it."
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