Vol 16 Edition 2

Pharmacotherapy key to effective hepatitis C treatment

Eliminating hepatitis C in Australia is now a real possibility, thanks to new direct-acting antiviral (DAA) drugs and the removal of two significant barriers to treatment according to Penington Institute Deputy CEO Dr Stephen McNally.

At the same time, the nation’s NSP workers have a central role in eradicating hep C.

“The Government’s decision that everyone with hepatitis C is eligible for treatment combined with no-cost access to DAA drugs is a significant step forward,” Stephen says.

“Everyone, including people who are currently injecting drugs, can now receive treatment knowing that there is a better than 95 per cent chance of clearing the hepatitis C virus.”

Treating hepatitis C has never been easier for health professionals or patients. But, three years on, the slow down in treatment uptake is a reality check for everyone working to make elimination a reality.

“We still have serious hurdles to overcome, such as people not knowing about the new treatments and either not believing, or not fully understanding, that the side effects and success rate have significantly improved from the old, harsh treatment regime,” Stephen says.

Most new hepatitis C infections (estimated at just over 10,000 each year) continue to be among people who inject drugs.

“One of our biggest challenges is finding effective ways to engage with one of the largest hepatitis C cohorts – people who inject drugs – while also strengthening existing and creating new pathways to treatment within a range of community-based settings.

“This challenge is also one of the biggest opportunities for needle and syringe program workers providing an important service to clients.”

Sustained pharmacotherapy plays an important role in reducing injecting, says Stephen, resulting in minimising hepatitis C infections and reinfections.

“It’s likely that treatment pathways will be jeopardised because people are unable to pay dispensing fees for their pharmacotherapy treatment, which will in turn weaken an important pathway for clients to engage with a local pharmacist about hepatitis C treatment,” he says.

Many people drop out of pharmacotherapy, as they cannot keep up with paying the daily dispensing fee. Between 65-75 per cent of clients have limited finances and are often on fixed incomes or government benefits with limited capacity to pay the additional costs.

A paper by Penington Institute with ASHM (Australasian Society for HIV Medicine) focuses on the current arrangements of pharmacotherapy in Australia and its implications for hepatitis C treatment. Stephen explains that the current funding arrangement for pharmacotherapy means that hepatitis C treatment costs will likely increase if steps are not taken to ensure pharmacotherapy is accessible and sustainable.

“In the paper we ask the question: what is the cost if someone gets infected or reinfected with hepatitis C because they could not maintain their pharmacotherapy?

“New arrangements need to be developed with community pharmacists and other primary health workers so that dispensing pharmacotherapy is viable and maximised for clients.”

– Sophie Marcard

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