Treatment access is only the first step to hepatitis C elimination

experience of universal anti-viral treatment access in Australia

Joseph S. Doyle, Nick Scott, Rachel Sacks-Davis, Alisa E. Pedrana, Alexander J. Thompson, Margaret Hellard, on behalf of the Eliminate Hepatitis C Partnership

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. Aim: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. Methods: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. Results: In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. Conclusions: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.

Original languageEnglish
Pages (from-to)1223-1229
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume49
Issue number9
DOIs
Publication statusPublished - May 2019

Cite this

@article{e9440e53968a42f0825bbf4a69d1bb90,
title = "Treatment access is only the first step to hepatitis C elimination: experience of universal anti-viral treatment access in Australia",
abstract = "Background: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. Aim: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. Methods: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. Results: In 2016, 32 877 individuals (14{\%} of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15{\%}) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24{\%} of all prescriptions but with a significantly increased proportion over time (9{\%} in 2016 Q1 to 37{\%} in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74{\%} to 38{\%} during the same period. General practitioners provided a greater proportion (47{\%}) of care in regional/remote areas than major cities. Conclusions: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.",
author = "Doyle, {Joseph S.} and Nick Scott and Rachel Sacks-Davis and Pedrana, {Alisa E.} and Thompson, {Alexander J.} and Margaret Hellard and {on behalf of the Eliminate Hepatitis C Partnership}",
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Treatment access is only the first step to hepatitis C elimination : experience of universal anti-viral treatment access in Australia. / Doyle, Joseph S.; Scott, Nick; Sacks-Davis, Rachel; Pedrana, Alisa E.; Thompson, Alexander J.; Hellard, Margaret; on behalf of the Eliminate Hepatitis C Partnership.

In: Alimentary Pharmacology and Therapeutics, Vol. 49, No. 9, 05.2019, p. 1223-1229.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Treatment access is only the first step to hepatitis C elimination

T2 - experience of universal anti-viral treatment access in Australia

AU - Doyle, Joseph S.

AU - Scott, Nick

AU - Sacks-Davis, Rachel

AU - Pedrana, Alisa E.

AU - Thompson, Alexander J.

AU - Hellard, Margaret

AU - on behalf of the Eliminate Hepatitis C Partnership

PY - 2019/5

Y1 - 2019/5

N2 - Background: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. Aim: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. Methods: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. Results: In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. Conclusions: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.

AB - Background: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. Aim: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. Methods: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. Results: In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. Conclusions: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.

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JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 9

ER -