The number of people with hepatitis C developing advanced liver disease complications (liver failure, primary liver cancer) and dying from liver disease-related causes will continue to increase at the current treatment level (3500 per year). Approximately 6000 people annually need to be treated to stabilise the number progressing to advanced liver disease. An increase of treatment uptake to 6000 per year would be highly cost-effective in terms of cost per quality adjusted life year gained, with increases to 8000 and 12 000 providing even further improvements.54 However, there is limited capacity in most of Australia’s specialist hepatitis C treatment services to treat more people and, as a result, waiting lists are growing in a number of jurisdictions. Greater capacity in the primary healthcare sector to contribute to service delivery in hepatitis C treatment and care is required and should be explored.
There are barriers for people from priority populations who want to access hepatitis C treatment. Barriers to accessing care and treatment for Aboriginal and Torres Strait Islander peoples, for example, include: limited knowledge of the virus; stigma and discrimination associated with transmission; lack of knowledge about the availability of treatment; and reluctance to access mainstream services.55 A recent report about Aboriginal and Torres Strait Islander peoples living in Victoria highlighted that finding the most appropriate and sustainable ways for those with hepatitis C to live well with the virus will achieve far more in reducing the burden of disease than attempting to find a model to increase the number in liver clinics across Australia.56
Custodial settings have the potential to be a focal point for hepatitis C testing, education and treatment for this priority population group. While hepatitis C treatment services are available for prisoners in some custodial settings, they are not consistently available nationally.
People from CALD backgrounds often confront barriers to accessing healthcare for hepatitis C, including communication difficulties and lack of access to professional interpreting services, poor access to written information in their preferred language, limited knowledge of the Australian healthcare system and poor awareness of their rights. Ethnic and cultural beliefs about BBVs, the meaning of blood and the nature of treatment and illness may negatively impact on their decision to pursue hepatitis C treatment.
The integration of injecting drug user peer support and hepatitis C treatment services has been demonstrated as acceptable and feasible for people contemplating, undergoing and immediately post treatment. The evaluation of such programs shows a strong preference for support provided by other people who inject drugs who have hepatitis C.57 Other initiatives such as phone-based peer support services for people with hepatitis C, their partners and carers, and people who are considering or currently undergoing hepatitis C treatment, are highly regarded, sought after and available in some jurisdictions.
Top of Page
Clinical testing of protease and polymerase inhibitors in combination with pegylated interferon and ribavirin for the treatment of hepatitis C genotype 1 is underway. It is possible that these new agents will be approved and in use during the life of this strategy. These treatments will potentially shorten the duration of treatment and improve response rates. In this context, access to and delivery of clinical services throughout Australia is important.
Following worldwide interest in expanding hepatitis C treatment options, delivery of hepatitis C treatment in opiate pharmacotherapy settings is underway and expanding in Australia. Evaluation of these initiatives is ongoing.58, 59
Priority actions in treatment, health and wellbeing
- Investigate innovative projects that increase the participation of general practitioners, nurses and other members of primary healthcare teams in the management of hepatitis C, including the delivery of treatment.
- Strengthen the capacity of existing tertiary hepatitis C treatment services to treat more people with hepatitis C and to support innovative models of care.
- Increase the participation across the health workforce in the delivery of hepatitis C management, including through the integration of peer support for people undergoing treatment and people who inject drugs.
- Implement innovative projects to link people with hepatitis C with support services at the time of diagnosis.
Top of Page
54 National Centre for HIV Epidemiology and Clinical Research 2009, Return on Investment 2: Evaluating the cost-effectiveness of Needle and syringe programs in Australia. University of New South Wales.
55 National Centre for HIV Epidemiology and Clinical Research 2009, Return on Investment 2: Evaluating the cost-effectiveness of Needle and syringe programs in Australia. University of New South Wales.
56 McNally S & Latham S 2009, Recognising and responding to hepatitis C in indigenous communities in Victoria, Australian Research Centre in Sex, Health and Society, Melbourne.
57 Norman J, Walsh NM, Mugavin J, Stoové MA, Kelsall J, Austin K & Lintzeris N 2008, ‘The acceptability and feasibility of peer worker support role in community based HCV treatment for injecting drug users’, Harm Reduction Journal, 5(8).
58 Treloar C & Fraser S 2009, Hepatitis C treatment: Increasing treatment uptake needs a critical view [Commentary]. Drug and Alcohol Review, vol. 28: pp. 436–40.
59 Treloar C, Newland J, Rance J & Hopwood M ‘Uptake and delivery of hepatitis C treatment in opiate substitution treatment: Perceptions of clients and health professionals’, Journal of Viral Hepatitis. In press. Accepted November 2009.