HBV eradication targets: can Australia still meet them?

Hepatology

By Mardi Chapman

22 Aug 2019

Australia is not on track to meet local or global targets regarding chronic hepatitis B.

Although treatment has prevented about 2,300 deaths in Australia between 2000 and 2017, only 8.7% of the estimated 221,420 people living with chronic hepatitis B in 2017 were receiving treatment, Victorian research shows.

This number is less than one third of those estimated to be eligible for antiviral treatment.

Mathematical modelling of chronic hepatitis B in Australia, incorporating migration and vaccination uptake trends, shows an estimated 246,673 people will be living with chronic hepatitis B in Australia by 2030, according to researchers at the Royal Melbourne Hospital, Victorian Infectious Diseases Reference Laboratory and University of Melbourne.

To reach the WHO 2030 target of 90% diagnosed, the proportion would need to increase by 1.72% every year to reach 222,006 people diagnosed in 2030, they say.

“For Australia to meet the National 2022 targets of 20% of people living with chronic hepatitis B on treatment by 2022, an additional 28,880 people will need to be receiving antiviral treatment. This would require an average annual increase of 2.3% which is 2.4 times the average annual increase of 0.93% per year since 2011,” they write in Hepatology.

And the flow-on from not meeting treatment targets would lead to a failure to meet mortality targets.

“If treatment uptake continues to increase at the current rate, there will only be a 5.7% reduction in deaths in 2030 compared to 2015. Furthermore, under the intermediate and optimistic treatment scenarios, the WHO 2030 target of a 65% reduction in hepatitis B related mortality is not met.”

“Our modelling shows that Australia is not currently on track to meet the National 2022 targets (of 80% of people living with chronic hepatitis B diagnosed, 20% on treatment, and a 30% reduction in chronic hepatitis B-related mortality by 2022) or the WHO 2030 targets (of 90% of people living with chronic hepatitis B diagnosed, and 80% of those eligible being on antiviral treatment).”

“Based on current trends the proportion of people living with chronic hepatitis B who have been diagnosed will reach 71% by 2022 and 81% by 2030, and treatment uptake will rise to 11.2% by 2022 and 12.9% by 2030, resulting in a 5.7% reduction in chronic hepatitis B-attributable deaths from 2015 to 2030.”

The researchers said the number of diagnoses and the number of people receiving treatment will need to substantially increase.

However, despite a relaxing of prescribing restrictions, most treatment is delivered by specialists creating disparities in access especially beyond major cities.

They said treatment scale-up acknowledging priority populations, particularly migrants from countries with high chronic hepatitis B prevalence and Aboriginal and Torres Strait Islanders, was required.

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