The prescribing of direct-acting antiviral (DAA) therapy for people with hepatitis C (HCV) has shifted from gastroenterologists to GPs since the drugs were made available on the PBS in 2016, new figures show.

While gastroenterologists and other specialists initially treated a high proportion of people with HCV when DAAs were first reimbursed, the trend has been for an increasing number of GPs to be treating small numbers of patients, according to an article published in the MJA.

The review of PBS dispensing data for DAAs covering the years 2016 to 2019 showed that in the first year up to 80% of prescribing was done by specialists in the first year, but by the end of 2017 GPs accounted for around half of all prescriptions.

During this period there were almost 83,000 patients with HCV who started treatment with DAAs, of whom around 43,000 (51%) were treated by a specialist including 30,000 (36%) by a gastroenterologist, whereas 36,000 (44%) were prescribed DAAs by a GP.

Of the 8208 practitioners prescribing DAAs, 75% were GPs and 10% were specialists including gastroenterologists (6%). Nurse practititioners accounted for less than 1%.

There was an early surge of DAA prescribing in 2016, when more than 33,000 patients were treated, after which rates declined to around one third of initial levels, with just over 11,000 people treated in 2019.

While about 1000 GPs were becoming new prescribers of DAAs annually, most (70%) were prescribing for small numbers (1-3) of patients, whereas most specialists prescribing DAAs were treating more than 10 patients per year.

The study authors, from the Kirby Institute, UNSW Sydney, said the findings showed the advantages of Australia’s model of wider DAA access, which goes beyond prescribing by specialists such as gastroenterologists, infectious disease physicians, sexual health specialists and addiction specialists.

“We found that the broad DAA prescribing authority in Australia has enabled a large number of GPs to contribute to DAA prescribing, important for health policies in settings with restricted access to therapy,” they wrote.

“The continuing increase in the number of GPs prescribing DAA and the number treating single patients suggest that GPs are gaining confidence in prescribing DAA therapy. This is an important foundation for further enhancing access to treatment.”

Meanwhile, another report from the Kirkby Institute has estimated that about half of people living with chronic HCV infection in Australia  have started DAA treatment.

The report also showed that since August 2018, when all regimens were available through PBS, 54% of individuals initiating DAA have been prescribed sofosbuvir/velpatasvir, and 37% have been prescribed glecaprevir/pibrentasvir.