Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: A modelling study

Kwon, Jisoo; Dore, Greg; Grebely, Jason; Hajarizadeh, Behzad; Guy, Rebecca; Cunningham, Evan B; Power, Cherie; Estes, Chris; Razavi, Homie; Gray, Richard T.; Duvnjak, Angella

doi:10.1111/jvh.13013

Cited by 60 publications

(76 citation statements)

References 32 publications

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“…To reach the WHO elimination targets of 80% of people with hepatitis C being treated and incidence being reduced to 80% of the 2015 level by 2030, the number of hepatitis C‐exposed people identified and tested needs to be increased by at least 50%. Our finding contrasts with previous modelling which suggested that Australia was on track to achieving the 2030 elimination targets; however, the earlier projection was predicated on treatment numbers being maintained at current levels. In our study, we additionally modelled the hepatitis C care cascade, and found that treatment numbers will decline to fewer than required to meet the elimination targets unless testing is increased.…”

Section: Discussioncontrasting

confidence: 99%

Australia needs to increase testing to achieve hepatitis C elimination

Scott

Sacks‐Davis

Wade

et al. 2020

Medical Journal of Australia

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In 2015, the first World Health Organization viral hepatitis strategy 1 set specific targets for the global elimination of hepatitis C as a public health threat by 2030: that the incidence of hepatitis C virus infections be reduced by 80% and hepatitis C-related mortality by 65%. A major strategy for achieving these targets is to increase access to highly effective direct-acting antiviral (DAA) treatments. The WHO viral hepatitis strategy includes two further targets for 2030: that 90% of cases of hepatitis C are diagnosed and that 80% of people with chronic hepatitis C are treated. 1

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Section: Discussioncontrasting

confidence: 99%

Australia needs to increase testing to achieve hepatitis C elimination

Scott

Sacks‐Davis

Wade

et al. 2020

Medical Journal of Australia

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“…368 Australia has made major progress in tackling bloodborne viruses and sexually transmissible infections over the past two decades. At the time of writing, the country could eliminate hepatitis C by 2030, and WHO reports 369 that hepatitis B prevalence in children is less than 1%. The current health workforce needs to increase to promote primary providers' awareness and knowledge of hepatitis B and C, and an increase in support, training, and mentorship for health-care professionals is needed to ensure successful testing, management, and treatment in primary health care.…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

411

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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“…The status quo assumed continuation of the current situation in the NSW prisons: a starting total prisoner population in 2017 of 14 683, including 7862 PWID, 3847 of whom were actively injecting at any one time (as reported ); 1400 individuals receiving OST at any one time from 2006 onwards ; and 200 DAA treatments per year from 2014 to 2016, 700 in 2016 and 1000 in 2017, again reflecting the actual scale‐up of DAA treatment in the NSW prisons. The impact of further scale‐up of DAA treatment provision, improved access to OST (implying both timely provision upon incarceration and suitable dosing, as well as increased numbers initiated on OST), introduction of NSP and also the expected reduction in community HCV prevalence due to the national DAA treatment rollout, were then tested (Table ) . Various combined treatment and prevention scenarios were then simulated based on these strategies (Table ).…”

Section: Projection Scenariosmentioning

confidence: 99%

“… bDerived from NSW estimates and projections . HCV = hepatitis C virus; DAA = direct‐acting antiviral; NSP = needle and syringe programme; OST = opiate substitution treatment.…”

Section: Projection Scenariosmentioning

confidence: 99%

Combined treatment and prevention strategies for hepatitis C virus elimination in the prisons in New South Wales: a modelling study

et al. 2019

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Background and aims Australia is currently on track to meet the World Health Organization (WHO) global hepatitis C virus (HCV) elimination goals by 2030, reflecting universal subsidized access to testing and direct-acting antiviral (DAA) treatment. In New South Wales, DAA treatment in prisons has scaled-up substantially, with 1000 prisoners treated in 2017. However, HCV prevalence and incidence in this setting is high, which could undermine elimination efforts. This study aimed to test the preventative effects of DAA treatment scale-up, opiate substitution treatment (OST) and needle and syringe programme (NSP) strategies for prisons. Design Modelling study using an individual-based mathematical model of a typical prison setting. The model was calibrated against Australian epidemiological data sets and executed in-prison events for each individual daily, including movements between prisons, changes in risk behaviour and uptake of prevention measures such as OST and NSP, as well as DAA treatment. Scenarios were projected from 2018 to 2030.Setting New South Wales prisons. Participants New South Wales prisoners. Measurements Variables including prison populations, prevalence and incidence rate were calculated. Prisoners were described by demographic characteristics, HCV infection history, risk behaviours and accessing treatment and prevention measures in varied security settings.Findings Increasing the number of prisoners treated for HCV to 2000 annually was projected to reduce the HCV incidence rate to 8.69 [95% confidence interval (CI) = 8.17, 9.20] per 100 person-years (100 p.y.). Combined treatment and prevention strategies were necessary to reduce the projected incidence rate to 5.22 (95% CI = 5.13, 5.52) per 100 p.y. Considering the expected reductions in the prevalence of chronic HCV in the Australian community, incidence rate was predicted to drop to 0.93 (95% CI = 0.92, 0.98) per 100 p.y. by 2030. Conclusions This model, which simulates prison scenarios to inform Australia's national hepatitis C virus elimination efforts, suggests that continued directacting antiviral (coverage in the community combined with a moderate increase of direct-acting antiviral treatments in prisons, and introduction of improved harm reduction via opiate substitution treatment and/or needle and syringe programmes, makes hepatitis C virus elimination feasible in Australian prisons.

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Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: A modelling study

Cited by 60 publications

References 32 publications

Australia needs to increase testing to achieve hepatitis C elimination

Australia needs to increase testing to achieve hepatitis C elimination

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Combined treatment and prevention strategies for hepatitis C virus elimination in the prisons in New South Wales: a modelling study

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