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In Prof Greg Dore’s exciting presentation on Friday at the 9th Viral Hepatitis Conference, Expanding access to hepatitis C treatment through primary care: Challenges and opportunities, he spoke about the HCV disease burden in Australia and the opportunities for increased involvement of GP prescribing whilst acknowledging some of the current barriers.
Despite an expanding burden of progressive liver disease, treatment numbers remain low at around 1%. Australia needs to increase numbers of people receiving antiviral therapy to around 6% as the numbers of people with cirrhosis are projected to reach over 37,500. Increased efficacy of future treatment alone will not significantly reduce the burden of disease. Greg noted the number of prescribers is a key determinant of treatment uptake.
GPs already manage very complicated patients with multiple chronic diseases, including HIV, and many are involved in addiction medicine. Data from recent studies, such as ETHOS and the ASHM GP Treatment Initiation Pilot, was presented and demonstrated HCV treatment can be provided successfully in primary care settings with efficacy rates comparable to tertiary centres. Greg acknowledged current barriers exist in expanding HCV treatment in primary care, such as the Highly Specialised Drugs regulations, existing HCV treatments are complex (but that these will change soon), that interferon-free direct acting antiviral therapy will likely have initial s100 restrictions and that there is still some conservatism among specialists. The need for primary care incentives was also highlighted.
Greg proposed strategies to increase assessment and treatment uptake which included changes to s100 regulations and antiviral therapy access through public health advocacy; simpler treatment assessment, treatment regimens and delivery; increased education and involvement of health care professionals.
In closing, Greg said it was time to move forward and not to pit one model of care against the other (e.g. GP prescribing vs nurse-led models), as there is a role for multiple models in order to increase the number of prescribers to treat the 10,000-15,000 people that is needed to reduce the burden of HCV in Australia. A person with a fibrosis stage F0 to F2 will not require ongoing monitoring once cured of their HCV, so the burden of HCV disease will decrease as more are treated.
It is exciting times in hepatitis C – what other chronic disease can offer a cure? Let’s work together and get as many treated as we can.