Making viral hepatitis elimination a reality: what does it mean, and how do we get there?

July 18, 2023

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Viral hepatitis remains one of the leading causes of liver cancer in Australia. Liver cancer is the fastest increasing cause of cancer death in Australia, with far lower survival rates than other cancers.

However, both hepatitis B and C are preventable and treatable, and in the case of hepatitis C – curable. That means there is a significant opportunity to tackle some of the leading causes of one of the most challenging cancers we face.

This year, in the lead up to World Hepatitis Day on July 28, we are unpacking the goal of eliminating viral hepatitis as a public health threat. What does this mean and importantly, how do we get there?

What does it mean to eliminate viral hepatitis as a public health threat?

The World Health Organisation (WHO) defines the elimination of viral hepatitis as a public health threat as a 90% reduction of new chronic cases. The aim is for this elimination to occur by 2030.

While the goal of eliminating viral hepatitis as a public health threat is key, it is also important to acknowledge the personal impact this can have as well. For Doctor Jacqui Richmond, who has worked as a nursing, education, research and policy professional in the viral hepatitis sector for more than twenty years, both of these factors must remain central in the discussion about elimination.

“What viral hepatitis elimination means to me is a reduction in incidence and prevalence, but also the opportunity to support people to be cured of a virus that makes them feel unwell, and a reduction in the associated morbidity and mortality,” says Dr Richmond.

“At an individual level, elimination is really freeing. At a population level, it’s a reflection of the science behind the cure and the opportunity we have to achieve elimination.”

Meaning that for both the individual and for our society, elimination will have a very real, positive impact.

How do we make viral hepatitis elimination a reality?

While the idea of eliminating a virus entirely may seem too good to be true, a multitude of factors mean viral hepatitis elimination remains well within the realm of possibility.

“We have the tools we need – a cure, accessible testing, pathways into care. What is required now is flexibility and an evolution in our approach, and the ability for the health system to adapt to the needs of marginalised people” says Dr Richmond.

Doctor Nada Andric, a General Practitioner of 15 years who primarily works with people experiencing homelessness, believes the possibility of elimination relies partly on changing attitudes towards viral hepatitis more broadly. 

“In my work, very commonly you’ll be able to see people that get cured, and of course they’re really happy. But then they feel like they can’t tell anyone. Something amazing has just happened, you’ve cured this chronic disease that you’ve been living with and worried about for such a long time, but you don’t have anyone to share that with because the stigma remains and you keep it from the closest people you have,” says Dr Andric.

For Dr Andric, part of the work that needs to be done to make viral hepatitis elimination a reality is centred on breaking down this stigma.

“Sometimes in your practice you’ll ask someone about hepatitis C and they’ll look at you like, ‘why are you asking me that question?’ So, I think that the idea that it’s a certain kind of person that has to deal with hepatitis is stopping people who don’t fit within those groups from engaging with testing, treatment and care,” she says.

Beyond that shift in the community mindset, Dr Andric argues systems-level change needs to occur to help streamline the path to testing and treatment for patients.

“When someone comes to see their GP, something like hepatitis might be the last thing on their mind. We need to have really clear guidelines to when we’re providing testing and treatment, something that allows us to bring hepatitis testing into the conversation without necessarily broaching topics like drug use or tattoos or whatever else it might be,” she says.

For both Dr Andric and Dr Richmond one thing is clear – reaching our elimination goals will rely on everyone, from health workers to the community being engaged and empowered to act.

“Wherever you are, we have an elimination role for you! Being part of a big, multidisciplinary team is essential to eliminating hepatitis C. We really need the support of the whole system, as well as continued funding and investment if we’re going to reach our goals. We need the government and funders to stay the course until 2030 and if that’s the case, we’ll be celebrating,” says Dr Richmond.

In the lead up to World Hepatitis Day, ASHM is hosting the International HIV Coinfection + Viral Hepatitis Elimination Conference in Brisbane, kicking off this Friday 21 July with a focus on strategies and approaches to ensure progress to the global elimination of hepatitis C and B.

As we work towards this significant goal, ASHM will also continue providing training, resources and programs to support our valued workforce who remain at the centre of viral hepatitis elimination. With projects like Beyond the C, supporting general practices test and treat hepatitis C, as well as new resources launched as part of the B Referred campaign to give guidance to primary care practitioners on referring patients with hepatitis B, ASHM is committed to working together to eliminate viral hepatitis as a public health threat.

This World Hepatitis Day we encourage all within our network to continue the discussion around viral hepatitis elimination, and stay engaged with the latest strategies, resources and advice to make this goal a reality.

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