Fall in liver transplants but concern over decline in treatment

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More action needs to be taken to ensure Australians living with hepatitis C gain access to the direct-acting antiviral cures reimbursed via the PBS, according to the authors of a new report that also found a reduction in liver transplants caused by the infection.

The Burnet and Kirby Institutes have issued an annual report that monitors Australia’s progress towards eliminating the disease. It has found fewer Australians are seeking testing and treatment for hepatitis C.

The report found an overall reduction in liver transplants in 2019. This was significantly driven by a fall in the number of transplants where hepatitis C infection was the primary diagnosis.

This fall was attributed to the use of direct-acting antiviral cures for hepatitis C but the report also found a continuing steady decline in the use of these therapies.

"When direct-acting antivirals (DAAs) were added to the Pharmaceutical Benefits Scheme in 2016, the treatment became affordable and accessible, and uptake was high. The decline in testing and treatment during 2019 is a signal for action," said the Burnet and Kirby Institutes.

Over 80,000 people have been treated with the DAAs since their reimbursement in 2016 but the new report shows uptake has steadily declined. After hitting a peak of 32,650 people in 2016, it fell to 21,560 in 2017, 16,490 in 2018 and 11,580 in 2019.

Over 100,000 people living with hepatitis C are yet to access treatment.

According to Professor Margaret Hellard, deputy director at Burnet Institute and an author of the report, “The report clearly shows the improved health outcomes DAAs deliver – people are achieving cure after accessing treatment and they are living free from hepatitis C. Very importantly, fewer people are progressing to need liver transplants because of hepatitis C.

The Kirby Institute’s Professor Gregory Dore, who is also a co-author of the report, said, “Australia has done exceptionally well at delivering DAA therapy, and connecting the most at-risk populations with testing and treatment. This report brings together data from across the country and gives us a good picture of how we are tracking. The key moving forward will be to use novel testing technologies and innovative screening initiatives to increase diagnosis and linkage to highly curative treatments, whilst also maintaining prevention initiatives such as needle syringe programs.”

This was the first year the report included information from the prison system. It shows an estimated 29 per cent of people treated for hepatitis C in 2019 were treated within the prison system.

“Within the prison system, we have an opportunity to use new rapid testing technologies to enhance linkage to care. With the high prevalence of hepatitis C in prisons, but often relatively short incarceration periods in remand settings, it is vital that we quickly test and connect people with curative treatments and support,” said Professor Dore.

Australia’s National Hepatitis C Strategy 2018-2022 is committed to the elimination of hepatitis C by 2030. 

However, Department of Health secretary Dr Brendan Murphy previously said achieving that goal would require the monthly initiation on treatment of 1,500 to 2,000 people. It has remained stuck below 1,000 for an extended period.