Despite the availability of curative direct acting antiviral (DAA) therapies, most people who are newly diagnosed with hepatitis C (HCV) do not receive treatment, an Australian study has found.

About a third of people who are newly diagnosed with HCV are lost to follow up or unable to access therapy because they are in prison, a  review of 200 consecutive new notifications in south west Sydney found.

The study led by Dr Elizabeth O’Brien of the Department of Gastroenterology, Campbelltown Hospital, found that only 47% of people received HCV treatment within 12 months of diagnosis.

Some were not treated because they became HCV RNA negative, indicating no active HCV infection, while others had co-morbidities or severe disease that precluded treatment.

Of the 62 specialist diagnosed cases of HCV that were eligible for treatment, 61% received DAA therapy, with the remainder either lost to follow up or in custody – two refused treatment.

But treatment rates were very low when people were diagnosed with HCV in primary care, with only five of 79 treatment-eligible people having DAA therapy initiated by a GP. Most ( 63%) were referred by GPs to a specialist for treatment, while a third were lost to follow up.

The study authors said the low treatment rates  – and frequent referrals for specialist review – seen in primary care could be explained in part because individual GPs would likely diagnose few cases of HCV (averaging one in five months), and might therefore lack experience in starting DAA therapy.

But it was a cause for concern that one third of patients were not treated because there was a lack of follow up with their clinician.

The authors noted there were a range of community-based programs that have been shown to improve engagement with HCV services and simplify the process from diagnosis to treatment.

“A consistent finding was that a rapid, simplified work-up, and a single-location integrated treatment clinic were associated with favourable outcomes,” they wrote.

Streamlining the work-up of cases might include coupling initial HCV-antibody testing with tests for viraemia and also the use of the pathology test-based APRI score rather than a specialised liver ultrasound, to determine whether a patient may have advanced liver disease.

There are also telementoring programs such as Project Echo that link GPs with specialist support to improve DAA uptake in the community, they added.

“This study highlights the need for resources to be allocated to provide targeted, proactive follow-up of patients newly found to be HCV antibody positive. These issues should be addressed in Australia’s effort towards HCV elimination, in line with the World Health Organization goal of HCV elimination by 2030,” they concluded.

The findings are published in Public Health Research & Practice.