Overnight in 2016, the treatment of hepatitis C virus (HCV) in Australia changed forever through the introduction of Direct-acting antivirals (DAAs) to the Australian Pharmaceutical Benefits Scheme (PBS). This month marks ten years since this vital turning point.
Prior to this, treatment for HCV typically took place in a hospital setting and scripts had to be written by a specialist. Now, all GPs and some nurse practitioners can prescribe DAAs and all retail pharmacies can dispense the medication.
Dr Annie Balcombe, a GP based in rural New South Wales has long been involved in the treatment of HCV. Speaking to ASHM on the milestone, she reflects on how far treatment for the virus has come.
“In 2009, as a GP, I become involved in hepatitis C way before the introduction of DAAs. I was closely involved in the prior treatment challenges,” she says.
“As an example of just how far management has come, back in 2009 the first challenge was simply to take HCV clinics out of the hospital setting.”
Dr Balcombe explains that before 2016, treating HCV was complicated and cumbersome for patients, requiring a liver biopsy (now no longer required thanks to the introduction of fibroscan) before a prolonged course of weekly interferon injections lasting 24 to 48 weeks, plus a swag of daily tablets that all had to be obtained via a hospital pharmacy.
With this, many experienced unpleasant side effects such as severe fatigue, anaemia, rashes and major depression. Additionally, the previous treatment excluded many due to pre-existing medical conditions and required frequent blood tests and clinic appointments pre, during, and post treatment.
As a result of all of this, many withdrew due to treatment side-effects and/or poor treatment response, and of those who stayed in treatment there was a low cure rate for patients, especially those with genotype 1 and cirrhosis.
Not only was treatment for HCV extremely challenging prior to DAAs, Dr Balcombe says that stigma was also a massive hurdle for many.
“Stigma often occurred in the health professional world and often oddly in hospitals. The stigma was based on a mix of fear and mistaken presumptions, such as you could catch HCV via hugging or kissing, or that if you had HCV, you must be actively using intravenous drugs and could not be trusted,” she says.
“In Australia the illegality of intravenous drugs has meant that a diagnosis of HCV carries a much greater level of judgement and blame compared to a diagnosis of advanced cirrhosis resulting from legalised heavy alcohol intake.”
“A significant number of people were exposed to HCV via other modes of transmission such as vaccination programs overseas, [or] blood transfusion but there was a public presumption that if you were diagnosed with HCV, you must have been exposed via intravenous drug usage.”
Dr Balcombe says that the introduction of DAAs has helped to reduce stigma surrounding HCV and so has the evolution of language used in relation to the condition.
“Extensive health professional and public education campaigns alongside an effective treatment has resulted in many seeking to be tested and an overall change of view that it a condition that can be easily managed and cured. All this has resulted in HCV becoming easier to talk about.”
“Though it may sound small, simple labelling changes in the health professional world from intravenous drug user (IVDU) to person who injects drugs (PWID) has also assisted in empowering and creating a less judgemental culture.”
With the availability of DAAs in 2016, HCV treatment was instantly simplified and now able to occur outside of specialised centres. Treatment today involves an eight or twelve-week course of tablets, with minimal side effects, and cure rates of over 95 per cent.
“When DAA’s first became available in 2016, Clinic 96 had over 100 patients living with HCV, awaiting treatment. By 2018, I had treated 149 people in general practice settings with 95 per cent achieving an HCV cure 12 weeks post treatment (SRV12). The uptake of treatment was enormous in the first two years due to the backlog of people across Australia,” says Dr Balcombe.
Moving forward to now, the introduction of DAAs has lead to a steady decline in new HCV infections. Between March 2016 and May 2025, a total of 112,863 people received hepatitis C treatment through the PBS and GPs were the prescriber for 34 per cent of people who received treatment from 2020 to 2025; non-GP specialists represented 39 per cent and nurse practitioners 14.7 per cent.
However, for Australia to reach its HCV elimination goal by 2023, in alignment with the World Health Organisation’s target of having 80 per cent of eligible people treated and an 80 per cent reduction in new infections, there are still challenges to overcome.
Dr Balcome explains these challenges include that over 60,000 people are estimated to still be living with HCV in Australia, plus those not engaging in care and management following a diagnosis. Plus, the ongoing need to improve and strengthen primary prevention by ensuring that most people who inject drugs do not share needles or syringes and thus also reduce the risk of re-infection.
“Ways to overcome some of these challenges include increased point of care testing in pharmacies and needle syringe programs to improve diagnosis and link immediately to treatment, ongoing HCV workforce education and training, ongoing health promotion campaigns targeting priority populations to increase awareness that treatment and retreatment is available and encourage engagement in care. Priority populations include drug treatment services, needle and syringe programs, services for people experiencing unstable housing, community corrections and prisons,” says Dr Balcombe.
As for what she hopes the next 10 years of HCV treatment in Australia will bring?
“Hopefully in 10 years, via increased focus on equity and engaging people that to date remain unreached, Australia will remain a global leader in HCV and have achieved the official WHO goal of eliminating hepatic C as a major public health problem.”
