Australia the Lucky Country when it comes to Hepatitis C

With wide access to needle and syringe programs, opioid subsitution therapy and hepatitis C treatment, Australia is leading the world in the elimination of hepatitis C. However, an emphasis on active case finding and continuing to move treatment into primary care is essential to maintain our momentum.


The Opioid Epidemic and Infectious Diseases: A Public Health Crisis

Presented by Sally Lynn Hodder, West Virginia University, Morgantown, USA

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Sally Lynn Hodder painted a sobering picture of the current opioid crisis in the US, and particularly in the Western Virginia region. I realised that Australia is indeed a lucky country, with our access to needle exchange and hepatitis C treatment. The West Virginia region of the US is an example of what could happen with the ‘perfect storm’ of increased opioid use, lack of preventative measures, and low access to hep C treatment. Drug overdose mortality has increased in the US, and is strongly associated with poverty.  The reported number of new hepatitis C infections have tripled since 2010 and unfortunately it is difficult to procure treatment. Medicaid requires fibrosis and for the patient to be drug free for 3 months. Therefore people who are most likely to transmit the virus are the least likely to be treated.

HIV statistics are more optimistic in the US with new HIV decreased by 18% in recent years, although this is to be expected as the proportion of HIV infection attributable to IDU is much lower than for HIV. However there has been concern about a couple of outbreaks of HIV in IDU community (Scott County Indiana and West Virginia). Infectious endocarditis, septic arthritis and osteomyelitis are also increasing.

What are the solutions to this problem? Substance abuse treatment certainly needs to be expanded, as do harm reduction services such as needle exchange programs, test and treat for hepatitis C, PrEP and hepatitis B vaccination. However this must be combined with social enterprise and economic development.


Global Elimination of Hepatitis C

Presented by Jordan J Feld, Toronto General Hospital, Toronto, Canada

View the Abstract | View the Presentation


Jordan Feld talked about the global elimination of Hep C, and explained the difference between eradication (reducing the prevalence to 0%) and elimination (reducing the prevalence to a level where hep C is no longer a public health issue). He recommended that we aim for ‘micro-elimination’ – elimination in high risk groups – not least because this measure might show impact at a political level.

It is estimated that 71 million people are infected with hepatitis C globally, however it is difficult to get accurate data, and in order to have global elimination countries need to prioritize high quality data. He also recommended that along the care continuum, the most impact can be produced by increased screening rather than diagnosis and treatment.

Again I felt proud to live in Australia, which is leading the world in hepatitis C treatment elimination. However the point was made that the first few years after the introduction of DAAs are easy and there needs to continue to be very active case finding. The message for Australia is to increase screening.

Other recommendations were to simplify the diagnostic process with reflex HCV RNA testing to decrease loss to follow-up. Again the emphasis is to shift treatment into primary care. And most importantly it is cost-effective, even with reinfection, to target the IDU community, who are the most likely to transmit infection. Globally, despite a massive uptake of treatment with DAAs, there has been little impact on hep C prevalence.

Last night I watched a television advert which advised baby boomers that 1 in 30 would be hep C positive, and encouraging testing, and I wondered how long it will be before a similar campaign commences in Australia.


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