6 March 2018
The Fourth National Hepatitis B Mapping Report 2016 and the First National Hepatitis C Mapping Report 2016 were launched today (pictured) by the WHO Collaborating Centre for Viral Hepatitis Epidemiology, The Doherty Institute in partnership with ASHM. These reports reveal geographic disparities in Australia’s progress towards the elimination of viral hepatitis, and data can be used to assess the progress Australia has made towards the National Hepatitis B Strategy 2014-2017 targets, the National Hepatitis C Strategy 2014-2017 targets, as well as the WHO Global Health Sector Strategy on Viral Hepatitis target for 2030 which Australia is a signatory to.
In Australia, both hepatitis C and hepatitis B can be treated by general practitioners, with 40% of chronic hepatitis C patients and 18% of chronic hepatitis B patients now being treated by a non-specialist physician. National Policy and Education Division Manager of ASHM, Vanessa Towell said “These reports show us that access to treatment and care for patients with viral hepatitis is not equitable across Australia. Primary care providers have an essential role in the diagnosis, immunisation, treatment and management of these conditions.”
- Localised priority-setting is a key objective of recent healthcare reform in Australia. In these reports, the geographic mapping across Australia's 31 PHNs (Primary Health Networks) of the prevalence of prevalence and uptake of treatment for hepatitis B and C allows for the prioritisation of health interventions and improvement of local service delivery in areas of greatest need.
- The geographically uneven distribution of CHB and CHC presents the opportunity to engage with, and improve awareness within, affected communities through the targeting of high prevalence areas.
- These reports will be updated annually, to reflect both the shifting epidemiology of CHB and CHC in Australia and evaluate the impact of public health and clinical service interventions on increasing access to diagnosis and treatment at a population level over time.
For more information about the management of viral hepatitis in primary care, including where to access further training, please see ASHM's training page and ASHM's S100 Hepatitis B Prescriber program.
Fourth national mapping project of Hep B shows great variance between highest and lowest prevalence areas
The prevalence of CHB varies considerably between Primary Health Networks (PHNs), and was three times greater in the PHN of highest prevalence compared to the lowest prevalence.
Engagement in care for CHB in 2016 was steady at 16.9% and treatment uptake at 7.2%, well short of National Strategy targets and with only small proportional increases since 2015.
Hepatitis B immunisation coverage has improved overall and in most PHNs, and with nearly half of all PHNs having achieved the 95% National Strategy target in 2016, although coverage was lower among Aboriginal and Torres Strait Islander children.
In 2016 in Australia, an estimated 237,894 individuals were living with hepatitis B, representing 1% of the population and now the most common blood-borne virus in Australia. However, only 62% of people living with the condition have been diagnosed. All people with chronic hepatitis B require regular monitoring, yet only 17% of Australians with chronic hepatitis B are receiving care. Only one PHN (South Western Sydney, 16.6%) reached the 15% treatment target set by the Second National Hepatitis B Strategy 2014-17. Treatment uptake was lowest in several regional and rural PHNs, at below 2% in Western Queensland (1.0%), Western NSW (1.3%), Country WA (1.6%), and Country SA (1.6%).
The majority (61%) of people living with CHB in Australia were born overseas, with the most common region of origin the Asia–Pacific (41% of the total). Smaller proportions were born in Europe (8%), Sub-Saharan Africa (4%), and North Africa and the Middle East (2%). Aboriginal and Torres Strait Islander people made up 11% of those affected, while other population groups with a high prevalence included people who inject drugs (6% of the total) and men who have sex with men (5%).
First national mapping project of Hep C shows areas with highest infection & lowest treatment rates
Hepatitis C prevalence is generally higher in rural and regional locations (lower in metropolitan)
Inaugural National Report allows each local area to track their progress and identify areas needing greater access to treatment
Australia has the potential to treat all people living with CHC and eliminate hepatitis C from the population
Curative treatment uptake for chronic hepatitis C (CHC) is generally at its lowest in local areas where prevalence of the virus is at its highest, according to the inaugural First National Hepatitis C Mapping Report 2016.
A year on from treatment being placed on the Pharmaceutical Benefits Scheme (PBS), the Project found uptake was less than half the national average of 19% in higher prevalence areas including Western Queensland (6.9%), Northern Territory (9.4%), and Brisbane South (10.7%). Areas with the highest coverage included Adelaide (25.9%), North Coast New South Wales (25.3%), and South Eastern Melbourne (25.1%).
Previous estimation of CHC prevalence and treatment uptake has provided national and state data, while this Project provides the first study of local areas, allowing health authorities and community organisations to find gaps in treatment, and identify priorities to work towards the future elimination of CHC.
Director of the WHOCCVH, Associate Professor Benjamin Cowie, said Australia had the potential to treat all people living with CHC.
“Australia is uniquely placed to achieve elimination of hepatitis C through partnership between people living with the virus, community organisations, clinicians and policy makers,” he said. “In some areas of the country, treatment uptake is three times higher than in others, so we need to focus on improving access for people living in under-serviced regions.”
“As we progress towards treating all people affected by hepatitis C, it will become increasingly important to track what is working, and to know where we are missing people who require access to treatment.”
Hepatitis C treatment is subsidised through the Australian Government via Medicare.
Who is Behind the Hepatitis B and C Mapping Project?
The WHO Collaborating Centre for Viral Hepatitis Epidemiology, The Doherty Institute and ASHM are working in partnership to produce a comprehensive understanding of the epidemiology of hepatitis B and C in Australia. The Viral Hepatitis Mapping Project commenced in 2012 and is funded by the Australian Department of Health.