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

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 8707234 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2036 (Electronic) Linking ISSN: 02692813 NLM ISO Abbreviation: Aliment Pharmacol Ther Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: [Oxford, OX] : Blackwell Scientific Publications, [c1987-

Health Services Accessibility*/standards ; Health Services Accessibility*/statistics & numerical data; Antiviral Agents/*therapeutic use ; Disease Eradication/*methods ; Hepatitis C/*diagnosis ; Hepatitis C/*drug therapy ; Practice Patterns, Physicians'/*statistics & numerical data; Antiviral Agents/classification ; Australia/epidemiology ; Disease Eradication/standards ; Disease Eradication/statistics & numerical data ; Early Medical Intervention/standards ; Early Medical Intervention/statistics & numerical data ; General Practitioners/statistics & numerical data ; Hepacivirus/immunology ; 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 ; Mass Screening/methods ; Mass Screening/standards ; Mass Screening/statistics & numerical data ; Rural Population/statistics & numerical data ; Specialization/statistics & numerical data

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.
(© 2019 John Wiley & Sons Ltd.)

International Victorian Government Operational Infrastructure Fund

Investigator: M Hellard; A Thompson; J Doyle; P Dietze; E McBryde; W Sievert; M Stoove; P Higgs; D Petrie; P Vickerman

0 (Antiviral Agents)
0 (Hepatitis C Antibodies)

Date Created: 20190326 Date Completed: 20200413 Latest Revision: 20200413

20231215

10.1111/apt.15210

30908706