Treatment access is only the first step to hepatitis C elimination: experience of universal anti‐viral treatment access in Australia

• Published in: Alimentary pharmacology & therapeutics Vol. 49; no. 9; pp. 1223 - 1229
• Main Authors: Doyle, Joseph S., Scott, Nick, Sacks‐Davis, Rachel, Pedrana, Alisa E., Thompson, Alexander J., Hellard, Margaret E., Hellard, Margaret, Thompson, Alex, Doyle, Joseph, Dietze, Paul, McBryde, Emma, Sievert, William, Stoove, Mark, Higgs, Peter, Petrie, Denis, Vickerman, Peter
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2019
• Subjects: Antiviral Agents - classification; Antiviral Agents - therapeutic use; Australia - epidemiology; Disease Eradication - methods; Disease Eradication - standards; Disease Eradication - statistics & numerical data; Early Medical Intervention - standards; Early Medical Intervention - statistics & numerical data; General Practitioners - statistics & numerical data; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Hepacivirus - immunology; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C Antibodies - analysis; Hepatitis C Antibodies - blood; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Humans; Infectious diseases; Mass Screening - methods; Mass Screening - standards; Mass Screening - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Rural Population - statistics & numerical data; Specialization - statistics & numerical data; Australia
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.15210

Summary Background Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. Aim To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct‐acting anti‐virals (DAA) across Australia. Methods We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. Results In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. Conclusions Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.