Warning over 2030 hepatitis C elimination target

A goal to eliminate hepatitis C as a public health threat by 2030 is at risk following a sharp decline in testing and treatment, according to a joint annual report released by Burnet Institute and the Kirby Institute this week.
 
Around 100,684 people living with hepatitis C started treatment between March 2016 and December 2022, according to the ‘Australia’s progress towards hepatitis C elimination: annual report 2023’.
 
It followed the introduction of antiviral medication onto the PBS in 2016, which allowed GPs to prescribe treatment directly.
 
However, treatment rates have declined significantly in recent years, the report authors warn. In 2016, 33,202 people initiated treatment, a number more than six times higher than the 2022 figure of 5205.
 
They estimate that around 74,400 Australians were still living with hepatitis C at the end of 2022.
 
For Dr Alisa Pedrana, the report’s editor, and a public health expert at The Burnet Institute, the decline is concerning after a promising start to universal availability of antiviral medications.
 
‘Initially, we had really high uptake of treatment,’ she told newsGP.
 
‘That was really because our healthcare providers had supported people to be diagnosed and ready to receive that treatment. As soon as it was available, we had that really quick uptake.
 
‘We were hoping it would plateau at about 10,000 [treatment initiations per year], and unfortunately, it hasn’t.’
 
Dr Pedrana says a lack of testing is a strong contributing factor, despite the improvements made in recent years.
 
However, she warns that even when diagnosis has taken place, treatment is far from guaranteed.
 
‘We are still seeing some challenges with initiating people into treatment who have been diagnosed,’ she said.
 
‘Only 50% of people diagnosed in that program are getting onto treatment, and that just shows us some of the challenges we have.
 
‘It’s not only about testing and diagnosing enough people but ensuring the right kind of models are there to support people to initiate treatment.
 
‘We recognise that it’s getting harder and harder, that people who need treatment, who haven’t yet been treated, have more complex issues.
 
‘They may have comorbidities, they’re also more likely to be experiencing homelessness, a history of prison incarceration, as well as other competing health and social priorities.’
 
She said supporting people who may legitimately not view hepatitis C treatment as their biggest health priority is an underlying challenge.
 
‘How do we allow them to get access to it so then they don’t have to worry about their liver health so much, and they don’t have to worry about hepatitis C yet later down the track?’ Dr Pedrana said.
 
Working out how to simplify treatment could be part of the solution, she believes.
 
‘That means when clients are coming into general practice, into AOD [Alcohol and Other Drug] clinics, into services where they are seeking other care that is more urgent – they might be wanting to get on to an opioid substitution therapy sort of drug treatment, they might be coming into a mental health service – a hepatitis C treatment may be an opportunistic addition to their healthcare,’ she said.
 
Dr Pedrana also believes certain shared care models could help.
 
‘We’re seeing the models that are working better now have really strong nurse engagement, they’re often nurse led, and GPs are providing the medical oversight,’ she said.
 
‘[GPs] will do a review, they’ll write a prescription, but they won’t necessarily be seeing all the clients because a lot of that can be task-shifted to nurses.’
 
The report pinpoints stigma as another factor hindering the strategy to eliminate the disease.
 
‘Importantly, this report highlights that stigma and discrimination towards people at risk of and living with hepatitis C is prevalent,’ it states.
 
‘Interventions to reduce stigma in the community and healthcare settings are critical to enable people to engage with hepatitis C testing and treatment services and continue progress towards hepatitis C elimination.’
 
The Head of the Viral Hepatitis Clinical Research Program at the Kirby Institute, Professor Gregory Dore, said targeted strategies are needed to build on the early successes after 2016.
 
‘Although Australia has made major strides towards hepatitis C elimination and is a world leader in access to prevention and treatment for marginalised populations, there needs to be a closer alignment between what the data is telling us and where more effective interventions are delivered,’ he said.
 
‘A key example is the need for enhanced services in the prison setting, including expanded access to opioid agonist therapy, and early detection and retreatment of reinfection.’
 
Like Dr Pedrana, Professor Dore remains optimistic that hitting the 2030 elimination target remains feasible.
 
‘With 74,400 Australians currently living with hepatitis C, elimination is possible if models of care are better designed to reduce barriers and reach those who are most at risk,’ he said.
 
Dr Pedrana, meanwhile, emphasised the positive impact successful treatment can have, both for the patient and medical practitioner.
 
‘There’s not necessarily any easy wins when you’re supporting people with complex care needs, and who also feel marginalised and socially stigmatised … it can be quite a difficult path,’ she said.
 
‘But curing someone’s Hep C in 8–12 weeks is just a fantastic outcome for anyone.’
 
The Department for Health and Aged Care states the elimination of hepatitis C as a public health threat as a goal for 2030 in its latest hepatitis C strategy.
 
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