Chronic hepatitis C burden and care cascade in Australia in the era of interferon‐based treatment

Hajarizadeh, Behzad; Grebely, Jason; McManus, Hamish; Estes, Chris; Razavi, Homie; Gray, Richard T.; Alavi, Maryam; Amin, Janaki; McGregor, Skye; Sievert, William; Thompson, Alexander; Dore, Gregory J.

doi:10.1111/jgh.13453

Cited by 62 publications

(69 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 Another key drawback in surveillance data is the reliance on clinician knowledge -and systematic recording -of patient characteristics, which may not always be complete. These limitations are of particular importance given that the estimated proportion diagnosed in Australia is 62% for HBV 7 and 75% for HCV.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

MacLachlan

Romero

Higgins

et al. 2020

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

Objective: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations.Methods: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior , during which time doctors were contacted for information about new diagnoses. Results:During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18-37% to 48-65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers.Conclusions: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health:Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

MacLachlan

Romero

Higgins

et al. 2020

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

show abstract

“…Despite a robust testing continuum for those accessing screening, BC remains similar to the US, Australia and other countries in initiating treatment (Maier et al, 2016, Viner et al, 2015, Lazarus et al, 2014, Hajarizadeh et al, 2016). We found that a small proportion (15%) of HCV diagnosed individuals initiated HCV treatment by 2012.…”

Section: Discussionmentioning

confidence: 99%

The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Janjua

Kuo

et al. 2016

EBioMedicine

Self Cite

View full text Add to dashboard Cite

BackgroundPopulation-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage.MethodsThe BC Hepatitis Testers Cohort (BC-HTC) includes 1.5 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR).ResultsWe estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%( 8532 ) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liver-related care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected.ConclusionsAlthough there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment.

show abstract

“…We produced estimates for Australia in 2015 using HCV notifications (HCV antibody) data from 1991 to 2015. The chronic HCV prevalence for 2015 was then obtained by summing all notifications since 1991 and adjusting for spontaneous clearance, mortality, emigration, and cure through interferon and DAA treatment …”

Section: Methodsmentioning

confidence: 99%

“…Further, all physicians, including drug and alcohol specialists and general practitioners, were able to prescribe DAA therapies. This unrestricted DAA access programme, an already high diagnosed proportion, and established high‐coverage harm reduction provide the foundation for HCV elimination in Australia. During the first 10 months of access to DAA therapies in 2016, 32 600 people were treated with DAAs for HCV infection (representing ~14% of the population with chronic HCV infection) .…”

Section: Introductionmentioning

confidence: 99%

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

Kwon

Dore

Grebely

et al. 2018

Journal of Viral Hepatitis

Self Cite

View full text Add to dashboard Cite

Summary Subsidized direct‐acting antiviral (DAA) treatment recently became available to all adults living with chronic hepatitis C virus (HCV) in Australia. Based on rapid uptake (32 600 people initiated DAA in 2016), we estimated the impact on HCV epidemiology and mortality in Australia and determined if Australia can meet the WHO HCV elimination targets by 2030. Using a mathematical model, we simulated pessimistic, intermediate and optimistic DAA treatment scenarios in Australia over 2016‐2030. We assumed treatment and testing rates were initially higher for advanced fibrosis and the same across HCV transmission risk level sub‐populations. We also assumed constant testing rates after 2016. We compared the results to the 2015 level and a counterfactual (IFN‐based) scenario. During 2016‐2030, we estimated an intermediate DAA treatment scenario (2016, 32 600 treated; 2017, 21 370 treated; 2018 17 100 treated; 2019 and beyond, 13 680 treated each year) would avert 40 420 new HCV infections, 13 260 liver‐related deaths (15 320 in viraemic; −2060 in cured) and 10 730 HCC cases, equating to a 53%, 63% and 75% reduction, respectively, compared to the IFN‐based scenario. The model also estimated that Australia will meet the WHO targets of incidence and treatment by 2028. Time to a 65% reduction in liver‐related mortality varied considerably between HCV viraemic only cases (2026) and all cases (2047). Based on a feasible DAA treatment scenario incorporating declining uptake, Australia should meet key WHO HCV elimination targets in 10 to15 years. The pre‐DAA escalation in those with advanced liver disease makes the achievement of the liver‐related mortality target difficult.

show abstract

Chronic hepatitis C burden and care cascade in Australia in the era of interferon‐based treatment

Abstract: The burden of HCV-related liver disease has increased markedly. Although the proportion diagnosed was high, treatment uptake remained low, with no increase over the last 7 years. Reducing the HCV burden in Australia requires scale-up of interferon-free HCV therapies.

Cited by 62 publications

References 41 publications

Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

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

Contact Info

Product

Resources

About