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.