06 Apr 2023
Significant gap in hepatitis B care in Victoria due to lack of diagnosis
The most prevalent blood-borne virus in Australia, chronic hepatitis B (CHB), poses a significant challenge for the public health system, with almost a third of Australians living with the contagious disease estimated to be undiagnosed.
A new study by researchers at the Peter Doherty Institute for Infection and Immunity (Doherty Institute) has found that disparities in care for CHB across the country will contribute to more deaths linked to CHB in most states and territories if improvements are not made.
Using a mathematical model of CHB in Australia, combined with data from Medicare and the National Notifiable Diseases Surveillance System (NNDSS), the researchers estimated the number of people with CHB who were diagnosed, engaged in care, and receiving treatment in each state and territory.
They found that, while there was a considerable increase in engagement in care and antiviral treatment in New South Wales and the Northern Territory, significant gaps in the cascade of care were observed in Victoria and Tasmania due to a lack of diagnosis.
Epidemiologist and Program Manager at the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, Royal Melbourne Hospital’s Nicole Romero, said that improving care for CHB in each state and territory will require a tailored approach.
“There are real inequities across Australia in the response to hepatitis B, with the proportion of people living with it and diagnosed ranging from less than 60 per cent to almost 80 per cent, and treatment uptake ranging from 7 per cent to 13 per cent across jurisdictions,” Ms Romero said.
“This study suggests that targeting specific identified gaps in care delivery in different states and territories may be necessary to achieve a more rapid and efficient improvement in the cascade of care for people living with hepatitis B”.
Senior author on the paper, Royal Melbourne Hospital’s Professor Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute, said that the Northern Territory provides an instructive example of what will be required to meet Australia’s commitment to eliminate the virus as a public health threat by 2030.
“The Northern Territory has seen a rapid increase in linkage to care and antiviral treatment in the last decade, increasing well ahead of national trends over the same period,” Professor Cowie said.
“This was achieved by investing in comprehensive health programs in partnership with affected communities, which is resulting in significant reductions in mortality due to hepatitis B.
“We have an evidence base for how to transform the cascade of care for hepatitis B in this country; what is needed now is commitment to achieve these outcomes nationwide.”
Peer review: Australian and New Zealand Journal of Public Health https://doi.org/10.1016/j.anzjph.2022.100011
Funding: Blood Borne Viruses and Sexually Transmissible Infections Surveillance Grant, Australian Government Department of Health (Grant 4-EOCQDHO)