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14 Mar 2018

Measuring disparities in access to hepatitis C treatment in Australia

The National Viral Hepatitis Mapping Project

On March 1 2016, new direct acting antiviral (DAAs) medications for chronic hepatitis C (CHC) treatment were made available on the Pharmaceutical Benefits Scheme (PBS) [1]. These treatments represent a huge advance and are a cost-effective way to prevent both new infections and deaths due to chronic infection. With cure rates greater than 90% with only 8-24 weeks of oral medication, and minimal side effects, DAAs have the potential to drastically reduce the impact of hepatitis C and potentially eliminate the disease in Australia [2].

Uptake of these treatments has initially been strong, with over one-fifth of all people living with CHC estimated to have received treatment in the first year of listing [2]. However, disparities exist in both the relative burden of CHC infection, and in the level of uptake of treatment, according to geographic area.

The National Viral Hepatitis Mapping Project, undertaken by the Epidemiology Unit at the Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Doherty Institute, in partnership with the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and funded by the Australian Federal Department of Health, utilizes national communicable disease surveillance data, along with records of people provided treatment through the PBS available from Medicare Australia, to map these parameters for each local area in Australia [3]. The project aims to assess disparities in access to treatment, and identify gaps in progress towards elimination goals [4].

Findings from this project have shown that in Australia in 2016 an estimated 227,306 individuals were living with CHC, representing 0.94% of the total population. However, this average prevalence varies greatly, from as high as 1.87% of the population in the Northern Territory to 0.41% of the population in Northern Sydney. Analysis of the distribution of cases of diagnosed CHC infection demonstrates that people living in rural areas are much more likely to be affected, and therefore these regions need to be prioritised for access to treatment.

Despite the universal, unrestricted access to DAAs for all people living with CHC over the age of 18, treatment uptake was also variable across Australia. Uptake was more than one-third higher than the national average of 18.8% in the Primary Health Networks of metropolitan Adelaide (25.9%), North Coast NSW (25.3%), and South Eastern Melbourne (25.1%), while areas of low uptake included Western Queensland (6.9%), Northern Territory (9.4%), and Brisbane South (10.7%). Concerningly, treatment uptake was often lower in areas of higher estimated prevalence, as well as in those with existing limitations in health service access, such as lower numbers of specialist physicians.

These findings highlight the need for localised assessment and targeting of CHC treatment needs to ensure equitable access to this revolutionary shift in health outcomes for people living with CHC infection. The National Hepatitis C Mapping Report, due to be published annually with the first version released in March 2017, will continue to measure progress in delivering these services, and provide locally relevant information to health services to allow tailoring of programs to meet the needs of people living with CHC.

 Authors: Jennifer MacLachlan (VIDRL), Laura Thomas (VIDRL)

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