Vol 15 Edition 1

Hepatitis C and people who inject drugs: what’s happening around Australia? (part 1)

Hepatitis C is a disease that has had serious impacts in Australia.

An estimated 800 people die from complications of the disease each year. It remains the number one reason for liver transplantation.

But in Australia we are now making strong inroads into tackling hepatitis C. Ground-breaking new direct-acting antivirals (DAA) treatments mean that the disease, if treated properly, can be cured with fewer side effects than previous treatments. Of those people who have been treated with these drugs so far around 95 per cent have been cured.

This is extremely positive news for Australians living with hepatitis C. But of course just because new treatments exist it doesn’t mean the disease is no longer having an impact.

In 2015, an estimated 227,310 people were living with chronic hepatitis C infection in Australia, among whom 19 per cent commenced DAA treatment between March 2016 and June 2017. It is estimated that there are now approximately 190,000 to 200,000 people living with chronic hepatitis C in Australia. This takes into consideration new infections.

The Australian Government has set an ambitious target to eliminate hepatitis C in Australia by 2030 and we must remember that people who inject drugs are a vital piece of the hepatitis C puzzle. The prevalence of people in this group who attend NSPs and have hepatitis C is 55-70 per cent and the majority of new infections in Australia are coming from people who share injecting equipment.

NSPs reach more people who inject drugs than any other service, so there is an important opportunity to capitalise on this connection.

Around Australia there are a range of programs in place that are making a difference for people who inject drugs.

Western Australia

  • Estimated number of people living with hepatitis C in 2015: 20,549
  • Uptake of DAA treatment in (March 2016 to June 2017): 3320 (16 per cent)

In Western Australia, Hepatitis WA and the WA Substance Users Association provide hepatitis C treatment clinics, with target groups including people who are currently injecting drugs.

A lot of work is underway to promote testing and treatment including the clever use of videos on social media to encourage more Aboriginal people to get tested and treated. Pre-packaged needle kits such as Fitpacks and Fitsticks, which are distributed through NSPs and sold in pharmacies, feature labels with useful information such as the importance of testing and the new treatments that are available.

One of the challenges Western Australia faces is developing more NSP sites, particularly in regional and rural areas where they are few and far between. Much more also needs to be done to develop and implement strategies to increase access to NSPs for Aboriginal and Torres Strait Islander people who inject drugs as well as access to sterile injecting equipment in prisons.

Northern Territory

  • Estimated number of people living with hepatitis C in 2015: 3606
  • Uptake of DAA treatment (March 2016 to June 2017): 430 (12 per cent)

The task in the Northern Territory is a difficult one given that the territory has such a small population size spread over a large area. Client and staff movement and staff turnover can make it difficult to engage clients about safe injecting practices, testing, treatment and follow up.

The territory has three primary NSP outlets, which handle around 80 per cent of occasions of service. The Northern Territory AIDS and Hepatitis Council (NTAHC) raises awareness about the availability of direct-acting antivirals with clients and works with people living with hepatitis C through its care and support program and sex worker outreach programs.

A lot of work in the territory involves spreading the message of blood-borne viruses, including hepatitis C, and the importance of getting tested. Specialist sexual health service Clinic 34 promotes testing for clients who inject and remote sexual health teams do the same. The Sexual Health and Blood Born Virus Unit and NTAHC deliver education as well as needle and syringe program orientation in primary care settings as well as the broader community. Awareness of hepatitis C is also promoted through events such as World Hepatitis Day and International Overdose Awareness Day.

Victoria

  • Estimated number of people living with hepatitis C in 2015: 55,261
  • Uptake of DAA treatment (March 2016 to June 2017): 10,770 (19 per cent)

The Victorian Hepatitis C Strategy 2016–2020 sets targets to increase prevention, testing and treatment of hepatitis C, and to reduce stigma and discrimination.

The Victorian Hepatitis C Elimination Working Group has been established to ensure as many Victorians as possible are screened, tested and able to access the new treatments, as quickly as possible. The Government has also partnered with the Primary Health Network Alliance to build specific and local hepatitis C clinical health pathways.

The Victorian HIV and Hepatitis Integrated Training and Learning program delivers comprehensive education and training for GPs on the diagnosis, treatment and management of hepatitis B and C. Meanwhile, the Eliminate Hepatitis C Partnership, a collaboration of service providers, government departments and researchers in Victoria, is aiming to increase the uptake of treatment for hepatitis C virus infection among people who inject drugs.

The focus can’t just be on just curing those who have been infected by hepatitis C, it is vital to work to help stop it spreading in the first place by reducing or preventing the sharing of injecting equipment. That also includes promoting testing and treatment and educating people who inject drugs about the disease.

– John Ronan

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