General Practitioner, VIC
Understanding the Epidemics (Modelling/Surveillance)
I am reporting from oral abstracts being presented at AVHEC17 regarding understanding the epidemics (modelling and surveillence).
The first talk , presented by Dr B Hajarizadeh (Kirby Institute, UNSW Sydney) , outlined results of Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) in New South Wales. This study was conducted in 4 prisons and revealed high HCV incidence in residents. It was confirmed that in almost all cases HCV transmission was primarily associated with intravenous drugs use. Prisoners almost always share needles so reinfection levels are twice higher than for primary infection. This study concludes the importance of introduction of wide preventive strategies including treatment as the very important part of prevention.
Jenny Iversen (Kirby Institute, UNSW Sydney) stressed the importance to monitor progress towards elimination of Hepatitis C infection in Australia. The Australian Needle Syringe Program Survey (ANSPS) examined treatment within PWID over the last 5 years to ensure quality of care . The study included self-completed questionnaire and dried blood spots serological testing. Associated factors (like age, gender, geographic location, frequency of drugs injections etc.) were also included in the study. This study was demonstrated high involvement of PWID with Hepatitis C infection after introduction of DAA under PBS. Further plans include recommendations for the RNA testing to confirm spontaneous and treatment induced clearance.
Amy Kwon (Kirby Institute, UNSW Sydney) presented Part of BBV & STI Research, Intervention and Strategic Evaluation Program hold in Australia to assess level of DAA required to eliminate Hepatitis C by 2030. Using mathematical model and three possible scenarios (optimistic, pessimistic and intermediate), it was concluded that Australia finally will meet the WHO HCV elimination targets in 10-13 years. Australia invests around 1 billion dollars (2016-2020) in elimination program without restrictions on stages of Liver disease. The treatment mostly includes DAA with no Interferons; re-treatment is also allowed. Some limitations – like internal migration or reinfections – were also taken into consideration, however would not have crucial influence on the process of elimination.
Recommendations for HCV testing were presented in a talk by Dr Nick Scott from Burnet Institute. He focused on models of care, treatment scale-up and care cascade among people who injects drugs in Australia. The suggestion was given for the additional testing (PCR test) to the HCV RNA. Effectiveness of such combination was confirmed statistically along with annual frequency of the testing. Such improvements in the testing system will make possible to achieve the WHO elimination target and minimize the likelihood of future outbreaks.
Kelly Hoskins (Continuous Quality Improvement Facilitator, Northern Territory Government) presented data about Hepatitis B infection in the Indigenous populations. The prevalence of HBV infection within Aboriginal community is much higher (up to 12%) than in general Australian population (1%). The project targeted on identification of those who are chronically infected and who never undergone HBV testing. The process was piloted in 5 Aboriginal communities and involved data collection and testing. The part of the project was also created (pointed?) to increase educational opportunity for the GP and other primary care providers for the proper Hepatitis B care with big attention to find all Chronic Hep B clients and engage them to the care.
Ms Maryam Alavi (Research Associate, Kirby Institute, UNSW Sydney) talked about the
burden of liver disease and comorbidities within PWID. The study revealed the importance of continuing to increase access to screening, care and treatment for individuals affected .
The final presentation by Karen McCulloch (Research Fellow, University Of Melbourne)
characterized populations with Hepatitis C to improve access to antiviral therapy programs. This study evaluated comorbidities and other characteristics of people who are current PWID and non-PWID in NSW. The higher rate of comorbidities was reported in people with HCV infection so longer hospitalization was usually needed in case of inpatient care.
Link through to oral abstracts and speaker presentations here