Australia needs to increase testing to achieve hepatitis C elimination

Scott, Nick; Sacks‐Davis, Rachel; Wade, Amanda; Stoové, Mark; Pedrana, Alisa; Doyle, Joseph; Thompson, Alexander; Wilson, David; Hellard, Margaret

doi:10.5694/mja2.50544

Cited by 57 publications

(57 citation statements)

References 15 publications

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“…A recent modelling study which utilises national-level testing data suggests that significant increases in hepatitis C testing are required in order to achieve elimination in Australia. [20] The observed increase in hepatitis C treatment rates reflects widespread treatment of patients chronically infected with HCV following the listing of DAAs on the PBS, and may also be reflective of shifting of treatment from tertiary health settings to primary care and community health clinics. Prior to 2016, hepatitis C treatment prescribing was restricted to GPs or nurses with specialised training and standard practice was to refer patients to specialist care for treatment, and thus patients' prescription data would not be captured.…”

Section: Discussionmentioning

confidence: 99%

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

et al. 2020

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Background Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. Methods De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1 st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods.

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Section: Discussionmentioning

confidence: 99%

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

et al. 2020

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“…11 Reaching the World Health Organization's 2030 target of HCV elimination requires a coordinated, multifaceted approach focusing on primary prevention, increased awareness of HCV, and case-finding with increased testing and treatment. 12,13 Significant investment has been made to educate and support Australian GPs to treat HCV. A number of resources have been developed to facilitate community-based treatment, for example Project Echo, which is a telementoring, group video conferencing tool used by Liverpool Hospital to link specialist hubs and primary care providers 14 ; however much more could be done to maintain the high rate of DAA uptake in Australia.…”

Section: Introductionmentioning

confidence: 99%

Public Health Unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia

O'Brien¹,

Whelan²,

Lama³

et al. 2021

Public Health Res Pract.

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• Less than half of patients newly diagnosed with hepatitis C virus (HCV) in South Western Sydney, Australia, who are eligible for antiviral treatment received such treatment in the 12 months after diagnosis • Most general practitioners referred new patients with HCV to specialists, rather than starting patients on treatment themselves. A significant portion of HCV notifications did not receive adequate follow-up • New Public Health Unit notifications of HCV represent a clear target for investment, to improve continuity of care in the quest towards HCV elimination

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“…Satisfaction with the success of HCV elimination in Australia to date is tempered by consideration of the challenges that lie ahead. As outlined in the modelling study by Scott and colleagues, DAA treatment numbers have declined, and projected estimates of HCV RNA testing (required for confirming current infections) indicate that they will need to be raised to achieve the 2030 targets.…”

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confidence: 99%

Hepatitis C elimination in Australia: progress and challenges

Martinello¹,

Hajarizadeh²,

Dore³

2020

Medical Journal of Australia

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mja2.50584 ▪ See Research (Scott).C urative direct-acting antiviral (DAA) therapy for people with chronic hepatitis C virus (HCV) infections 1 has transformed clinical management and spurred ambitious World Health Organization elimination targets for 2030. 2 WHO service targets encompass marked improvements in prevention, diagnosis, and treatment; impact targets include a 65% reduction in HCV-related deaths and an 80% reduction in new HCV infections compared with 2015. 2 In 2015, an estimated 71 million people were living with chronic HCV infection. Progress toward elimination since the launch of the WHO viral hepatitis strategy in 2016 has been patchy; globally, only 20% of people with chronic HCV infection are diagnosed, and an estimated 1.75 million people are infected with HCV each year: more than the number of those cured by DAA therapy. 2 In 2018, only a small number of countries, including Australia, were on track to achieving the WHO HCV elimination targets by 2030.In Australia, about 85 000 people with HCV infection had been treated with DAA therapy by the end of 2019. Importantly, DAA uptake appears higher among populations at risk of transmission, including people who inject drugs and HIV-infected gay and bisexual men. [3][4][5] The Australian government developed a unique model that provided unrestricted national access to DAA therapy over five years, with an annual expenditure cap. 6 A return on this therapeutic investment can already be seen in terms of reduced numbers of people with complications of advanced liver disease and of liver disease-related deaths, 7 but sustained government funding and support will be crucial.Satisfaction with the success of HCV elimination in Australia to date is tempered by consideration of the challenges that lie ahead. As outlined in the modelling study by Scott and colleagues, 8 DAA treatment numbers have declined, and projected estimates of HCV RNA testing (required for confirming current infections) indicate that they will need to be raised to achieve the 2030 targets.While acknowledging the importance of increased HCV testing and linkage to care, several factors justify greater optimism. First, our recent downward revision of the estimated number of people with chronic HCV infection in 2015, from 227 000 to 188 000 (largely because of duplicate HCV notifications), means that the starting point for HCV elimination is 17% lower.Second, there is increasing evidence of higher DAA uptake among people at greater risk, including people who inject drugs or are imprisoned. The model reported by Scott and colleagues assumed comparable access to DAA therapy across populations at low and high risk of infection, with a sensitivity analysis evaluating the effect of reduced uptake by people who inject drugs. A sensitivity analysis evaluating higher uptake would be more appropriate, and would probably predict earlier HCV elimination.Third, the authors' model was based on absolute numbers of diagnostic (qualitative) HCV RNA tests. As the authors mention, it is likely that man...

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Australia needs to increase testing to achieve hepatitis C elimination

Cited by 57 publications

References 15 publications

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

Public Health Unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia

Hepatitis C elimination in Australia: progress and challenges

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