Vol 15 Edition 2

Hepatitis C and people who inject drugs: What’s happening around Australia? (part 2)

In Australia around 190,000 to 200,000 people live with hepatitis C, a disease that causes around 800 deaths across the country every year. New direct-acting antiviral treatments can cure around 95 per cent of hepatitis C cases – all people have to do is take a few tablets which have minimal side effects.

However, just because new treatments exist doesn’t mean that people who are living with hepatitis C are accessing these treatments. In fact, the uptake of these ground-breaking treatments has slowed in Australia and the high incidence of this virus amongst people who inject drugs makes hepatitis C a major public health challenge.

Some people who inject drugs have minimal contact with the health care system and experience feelings of marginalisation. They may not even be aware that new hepatitis C treatments are available and that they are more effective (and with fewer side effects) than old versions. These are all major obstacles to encouraging more people with hepatitis C to undergo testing and treatment.

To address these issues and eliminate hepatitis C, states and territories around Australia are acting decisively. As you may recall, in the February 2018 edition of the Anex Bulletin we provided a snapshot of programs in place around Australia that are making a difference in tackling hepatitis C rates for people who inject drugs.

Now it’s time for part two, which takes us to Queensland and the Australian Capital Territory.

ACT

  • Estimated number of people living with hepatitis C in 2015: 3591 (Source: The Kirby Institute. Hepatitis B and C in Australia Annual Surveillance Report Supplement 2016.)
  • Uptake of DAA treatment in (March 2016 to June 2017): 1130 (30 per cent) (Source: The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (Issue 8) December 2017)

The ACT is making strong headway in encouraging people to access hepatitis C treatment. In 2016, it had the highest proportion of treatment uptake rates in Australia with 30 per cent of people living with hepatitis C starting direct-acting antiviral therapy during the period March 2016 to June 2017.

The Barr Government has set ambitious targets to reduce the incidence of new hepatitis C infections by 50 per cent by 2020 and increase the number of people who receive the new treatments by that same rate during the period. To achieve this, hepatitis C treatment is available not only at the Canberra Hospital Liver Clinic and via the territory’s GPs, but also at the ACT prison the Alexander Maconochie Centre (AMC). Between March 2016 and March 2017 58 AMC detainees commenced new treatments and 55 of them experienced effective treatment outcomes, which highlights how successful the new treatments can be.

A key component of eliminating hepatitis C is preventing people contracting it in the first place – a high risk for people who engage in risky injecting practices. There are 10 needle and syringe outlets across the territory and 30 community pharmacies that distribute sterile injecting equipment as well as six needle and syringe vending machines accessible 24 hours a day, seven days a week. Legislation has also been passed decriminalising the peer distribution of sterile injecting equipment to prevent the spread of blood-borne diseases.

Queensland

  • Estimated number of people living with hepatitis C in 2015: 47,356 (Source: The Kirby Institute. Hepatitis B and C in Australia Annual Surveillance Report Supplement 2016.)
  • Uptake of DAA treatment in (March 2016 to June 2017): 8400 (18 per cent) (Source: The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (Issue 8) December 2017)

Queensland is a large state covering more than 1.8 million square kilometres so ensuring sterile injecting equipment is available in all communities is a colossal task. Many Australians outside of Queensland don’t realise that the distance between Brisbane in the south east of the state and Cairns in the far north is the same distance as Melbourne to Brisbane.

Also, unlike other states with highly centralised populations Queensland has a large number of regional cities right up and down the coast. With such a highly dispersed population, the Government sees GPs are crucial to winning the hepatitis C battle. The new hepatitis C treatments are so straightforward and effective that no specialist skills are required, meaning that GPs across Queensland can play a significant role in curing people carrying the disease.

When it comes to preventing hepatitis C, there are 120 secondary and 24 primary NSP sites in Queensland with all primary sites offering treatment or referral into local treatment pathways. The Government also funds QuIHN, a non-government organisation that runs three large NSPs. In addition to providing sterile injecting equipment and disposal options, QuIHN is also responsible for referring people to health services as well as peer education and workforce development.

Queensland’s remote communities, which feature high numbers of Aboriginal and Torres Strait Islander people, aren’t experiencing high rates of hepatitis C (unlike hepatitis B). However, people who identify as Aboriginal or Torres Strait Islander living in the state’s cities do have higher rates of the hepatitis C. In some of Queensland’s NSPs in locations such as south Brisbane, the proportion of clients identifying as Indigenous is as high as 20 per cent. The good news is that they are getting treated at roughly the same rate as everyone else.

The Australian Government has a target of eliminating hepatitis C Australia-wide by 2030. We have the right treatments available to cure the clear majority of people with hepatitis C. The challenge lies in reaching those people who have the disease but don’t have strong contact with the health system.

– John Ronan

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