Hepatology

Postcode lottery for hepatitis C elimination as treatment rates decline


While some regions of Australia are on track to achieve targets for eliminating hepatitis C, most are falling behind, according to the latest annual report from the  Viral Hepatitis Mapping Project.

The data up to June 2019 shows an estimated 39.5% of all Australians living with chronic hepatitis C (74,000) have received treatment with direct-acting antivirals (DAAs since they were listed on the PBS in March 2016.

However, recent trends show the number of people being treated is continuing to decline over time, and Australia will not meet the 2022 National Strategy treatment target of 65%.

After an initial high rate of uptake of DAAs, the number of treatment initiations for hepatitis C fell from a peak of 5,000 per month to fewer than 1000 per month.

Treatment uptake has been highest in South Australia (50%) and Victoria (48%) but low in states such as WA (34%) and in the Northern Territory (16%).

According to the report’s author’s even at current rates, less then a third of Australia’s 31 Primary Health Networks will meet the National Strategy 65% treatment target for 2022. All of these are in urban and inner regional locations, with more remote regions being those in greatest need of increased access to treatment.

The report also shows that a large decline in treatment of chronic hepatitis C by specialists means that prescribing of DAAs now predominantly by GPs, whose proportion of total DAA treatment rose from 10% in 2016 to 49% by 2019.

“As was the case in previous years, people treated by specialists were older on average, with 56.7% over 50 years of age, compared to 39.6% of those treated by GPs,” the report notes

GPs overwhelmingly prescribed 8- or 12-week durations of therapy, compared to 83.2% of specialist treatment initiations, likely because specialists will be managing hepatitis C in people with previous treatment history and with cirrhosis, it noted.

The shift to GP prescribing was accompanied by a decrease in the proportion of patients who had testing to confirm a sustained virological response (SVR), which fell from 77% in 2016 to 58% for people who began treatment in 2018.

Professor Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, and one of the report’s authors, said that having four out of every ten people hepatitis C treated with DAAs was a major step forward, but the progress to targets was losing momentum.

“While this is clearly a huge step forward, given reducing rates of treatment initiation, we must find ways to engage with people who have not yet accessed treatment,” he said.

“Furthermore, with 22 of Australia’s 31 PHNs not on track to achieve the National Strategy target of 65% treatment uptake, greater efforts in these areas are clearly needed. We must not allow place of residence to determine who can be cured of hepatitis C; no Australians should be left behind as we strive for the elimination of hepatitis C as a public health threat.”

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