Experts call for robust systems to save thousands lost to care.

Thousands of Australians developing serious liver complications from untreated hepatitis B could have their lives transformed if robust screening and follow-up – which is showing early signs of success in the Northern Territory – was rolled out nationally.

Led by the Menzies School of Health Research, the NT program has provided information about hepatitis B in local Indigenous languages for the first time through the Hep B Story app. The program also includes health professionals visiting remote communities to provide a one-stop liver shop and documenting the hepatitis B status of the population. 

Recently awarded an NHMRC partnership grant, the Menzies School of Health Research is collaborating with the NT Department of Health, Miwatj Health Aboriginal Corporation, Katherine West Health Board, ASHM and NTAHC, to translate the Hepatitis B Story app into ten more Aboriginal languages and to ensure more people receive vital care for hepatitis B. 

Presenting at the 11thAustralasian Viral Hepatitis conference in Adelaide, Dr Jane Davies said that the NT’s approach to care for hepatitis B meant that the “amazing progress we have made to identify, engage, monitor and treat people with hepatitis B will not be lost over time”.

“Engaging people with appropriate information about hepatitis B is absolutely critical. In a separate pilot project in Arnhem Land, we are systematically documenting everyone’s hepatitis B status and providing follow up care so that no one is left behind,” she said.

“In the Arnhem Land pilot, we are already exceeding the national target for engagement in care and treatment – and we recognise that a registry of some kind is essential to ensure long term engagement and keeping people in care.

“We have already documented the hepatitis B status of around 18,000 people in the NT – where we estimate around 3-6 per cent have hepatitis B. This means for those diagnosed we can be confident in providing the care needed to reduce the risk of liver damage,” Dr Davies said.

The pilots have been so successful that they have been hailed as likely to eliminate new cases of hepatitis B in the Northern Territory within five years and enable the provision of gold standard care to people living with the virus. 

More than 230,000 Australians are living with chronic hepatitis B and an estimated one in three people living with the virus – around 85,000 Australians – remain undiagnosed. This puts them at increased risk of liver damage and liver cancer.1

Chronic hepatitis B disproportionately affects Aboriginal and Torres Strait Islanders, particularly from rural and remote communities, and people from Asia Pacific regions and parts of Africa.2 

Hepatitis Australia CEO Helen Tyrrell said the NT program was a “fantastic example of how hepatitis B treatment can be transformed with the right interventions”. 

“Many thousands of people living with hepatitis B are missing out on vital care, either because they have never been tested, or because they were lost to follow up care. This means they are at increased risk of life-threatening complications that are preventable.

“Identifying people at high risk of living with the hepatitis B virus can be as easy for GPs as confirming place of birth or Indigenous status. But diagnosis on its own is no use to anyone, without long-term monitoring and timely treatment to guard against complications and avoidable deaths,” Ms Tyrrell said. 

For many years, onlyseven per cent of people with the virus have been receiving treatment, well below the national target of 15 per cent.1 Unless people with chronic hepatitis B are diagnosed and adequately monitored and treated around a quarter will die from the virus, either from liver failure or liver cancer.3

A primary care-based strategy in New South Wales4found that GPs who were involved in systematically screening, managing or referring people with hepatitis B increased antiviral treatment uptake to 18 per cent, which reduced cases of cirrhosis and liver cancer. Importantly, hepatitis B related deaths were reduced by 56 per cent, compared to the current practice of unsystematic screening and treatment. 

Ms Tyrrell said the hepatitis community was hopeful that a cure for hepatitis B will become available in the next decade, but in the meantime “ongoing investment across Australia is vital to provide integrated and culturally appropriate education and testing combined with robust monitoring and timely treatment to prevent thousands of Australians developing life-threatening complications”.

“We need to learn from the Northern Territory and New South Wales experiences to create stronger systems across Australia. Critically, all those who are diagnosed with hepatitis B must be regularly followed-up and receive gold standard care while we wait for a cure,” Ms Tyrrell concluded.

If you are living with hepatitis B visitwww.hepatitisaustralia.com  

Or call the National Infoline 1800 437 222. 

The Hep B Story App freely available viahttps://www.menzies.edu.au/page/Resources/Hep_B_Story/