Tracking progress towards Viral Hepatitis Elimination

A/Prof Rebecca Guy, Head of Surveillance, Education and Research Program, Kirby Institute UNSW, Australia, discussed the importance of Epidemiology and measuring our response at an Australian national level as we strive towards the WHO Hepatitis B and Hepatitis C targets.

She highlighted parts of the tracking process using examples of data from various specific population groups. The HCV prevalence of participants from NSP is around 55%, the highest incident in any group, with only 50% reporting a HCV test in the previous 12 month period. Of particular concern is the number of <25 year olds with HCV notifications that had not declined but remained at 15%. A measure of risk behaviour showed the incidence of needle/syringe sharing in the past month amongst people who inject drugs is around 15%.

We were reminded of the importance of our task as the number of people suffering from severe complications of HCV infection (cirrhosis/ hematoma/ death) continues to increase gradually.

Australia has made a dramatic response to the availability of DAAs by treating over 30,000 HCV in 2016, though our response needs to be sustained at more moderate levels in order to achieve Elimination of HCV in our nation by 2030.

With regards to HBV the incidence of notifications in young people < 24 continues to decline, likely to be a result of our Hep B childhood vaccination program. However, the HBV Diagnosis and care cascade continues to lag behind that of HCV.

In the Epidemiology sense, WHO targets currently set are defined as "elimination as a public health problem" rather than eradication (reduction of the world wide incidence to zero) or elimination in its stricter sense (cessation of transmission of a disease in a single country).

There are a number of ways of tracking progress towards elimination of HCV as a PHP.

1. Modelling showed that while the number of new patients initiated on DAA will decline after the warehouse effect has passed, the WHO targets can be achieved before 2030 by intermediate estimates.
2. Data at a finer geographical level showed widely differing treatment levels of both Hep B and Hep C across geographic regions of Australia and the need for targeted action in geographic locations.
3. Collection and feedback of health service delivery data to individual sites or groups of services provides valuable insight and highlight specific needs and facilitate tailored management.
4. Identify and overcome various barriers to accessing prevention services
5. Importance of measuring new cases of HCV infection using HCV RNA testing as well as HCV antibody testing.
6. Improve the completeness of Indigenous data.

A key part of this is the use of "data linkage" where information from all sources of hepatitis C related data are fed back to a central HCV notification centre to facilitate research analysis.

It is vital that we collect and feedback this data to the various local, state and National organisations for future Hepatitis Elimination management in Australia.

See also selected speaker presentations from this session, including:

• Global burden of hepatitis & use of pooled procurement to expand access by Homie Razavi (Managing Director, Center For Disease Analysis)
• Where is New Zealand in the race to eliminate Hepatitis C? by Ed Gane (Hepatologist, Auckland City Hospital)