Elimination of hepatitis C in Australia

Hepatitis C infection is a major public health challenge for Australia. People with chronic hepatitis C are at risk of cirrhosis, liver failure and hepatocellular carcinoma.

Hepatitis C is curable, and cure is associated with improvement in quality of life and prevention of liver-related morbidity and mortality. Importantly, curing hepatitis C prevents transmission of infection, and treatment targeting people with ongoing risk, including those who inject drugs, will reduce prevalence of hepatitis C in the community.

Note: Hepatitis C virus infection is curable.

Interferon-based regimens were previously used to treat hepatitis C; these regimens had limited efficacy and were poorly tolerated. The introduction of highly effective and well-tolerated direct-acting antiviral therapies for hepatitis C represents a major advance, and all Australians with hepatitis C should be considered for therapy.

Direct-acting antiviral regimens are administered orally and (for the pangenotypic regimens) consist of one or three tablets taken daily for a duration of 8 to 12 weeks. Direct-acting antivirals may be prescribed by any medical practitioner or nurse practitioner who is experienced in treating hepatitis C, or in consultation with a specialist experienced in the treatment of hepatitis C. These drugs can be prescribed in different settings, including in the community and in prisons.

Note: Direct-acting antiviral drugs for hepatitis C are administered orally and are highly effective and well tolerated.

The World Health Organization (WHO) has set targets for the elimination of hepatitis C as a public health threat, aiming for an 80% reduction in the incidence of new hepatitis C infections and a 65% reduction in mortality due to hepatitis C by 2030. These targets have been endorsed by the Australian Government. Achieving the WHO targets in Australia will require:

  • harm reduction strategies to reduce new infections (eg needle and syringe programs, opioid replacement therapy)
  • targeting populations with a high risk of transmitting hepatitis C (eg people who inject drugs) for treatment, to prevent new infections
  • increasing testing, diagnosis and treatment numbers overall.

Ongoing efforts are required to maintain the uptake of direct-acting antiviral therapy, particularly in marginalised groups. Such efforts should include enhanced screening and greater access to treatment in drug and alcohol services, community clinics, mental health services and prison clinics.