Fighting for the future with hepatitis C treatment in general practice.

Source: News GP - RACGP  Author: Amanda Lyons

GPs are a major part a new treatment that can eliminate hepatitis C in Australia, but more patients need to be identified to achieve the best results.

The Federal Government subsidised a range of direct-acting antivirals for the treatment of people with any genotype of hepatitis C in March 2016. These drugs, which have a cure success rate of 90–95%, were made available through the Pharmaceutical Benefits Scheme (PBS) for all people with the disease over the age of 18, making Australia one of the first countries to offer this treatment so widely.
 
But after an initial surge of treatment – when 4000 people took up the drugs a month– the momentum of direct-acting antivirals through general practice has slowed considerably.
 
‘We’ve made a huge impact and the first wave’s been treated, but there’s a second and third wave that are going to be harder to contact and get into the system,’ Dr Annie Balcomb, a GP with a special interest in viral hepatitis, told newsGP.
 
Dr Balcomb believes that not only are the drugs ‘revolutionary’, but so is the fact that Australian GPs are able to prescribe and manage them.
 
‘Australia is in such a lucky position in that GPs can treat hepatitis C and we can get [the treatment] from community pharmacies; the rest of the world is looking at us and going, “Wow”,’ she said.
 
The drugs are funded for five years in line with the Federal Government’s Fourth national hepatitis C strategy 2014–2017, providing an incentive to treat as many patients as possible by 2021.
 
‘The overall cost of treatment to the government decreases as more people are treated under the current five-year agreement,’ Helen Tyrell, Chief Executive Officer of Hepatitis Australia, told newsGP. ‘A rapid scale-up of treatment is beneficial for the healthcare budget and will additionally help bring about a faster reduction in the burden of disease and pressure on the health system.’
 
There are a range of reasons that remaining patients with hepatitis C may experience barriers to treatment, but one of the strongest is the stigma surrounding the disease due to its association with intravenous drug use. This may not only prevent patients from coming forward, but may also stop practitioners from recognising these cases among their own patient populations.
 
‘You’d be surprised who has undiagnosed hepatitis C,’ Dr Balcomb said. ‘All sorts of professional people, anyone from any strata of society may well have been exposed. There are also people who were born overseas in high-risk countries, with risk of vertical transmission. A lot of those people get missed.
 
‘So anyone who has slightly raised AST/ALT [aspartate transaminase/alanine transaminase], or any of the risk factors for hepatitis C – if they haven’t had a hepatitis C test, then do it.’
 
Dr Balcomb believes people in all parts of the community need to make an effort to combat stigma associated with hepatitis C.
 
‘[Injecting drug users] are a marginalised group, on the whole,’ she said. ‘I think maybe because it’s illegal; we don’t treat alcoholics or smokers the same way.
 
‘But it’s something we need to address, make it routine to ask about recreational drugs and take the judgement out of it.’
 
Although the issue of hepatitis C may seem difficult to approach in consultations, direct-acting antiviral treatment offers significant benefits and provide hope for the future.
 
‘The ultimate goal of providing the broadest possible access to the direct-acting antivirals cures is the elimination of hepatitis C as a public health threat by 2030,’ Tyrell said. ‘Every patient initiated on hepatitis C treatment by a GP not only helps the individual patient achieve a cure, but also contributes towards the elimination of hepatitis C in Australia.
 
‘It is rare to have the opportunity to contribute to such a significant health goal.’
 
Dr Balcomb unreservedly agrees, believing the ability to prescribe direct-acting antiviral treatment presents GPs with a ‘wonderful opportunity’.
 
‘If we can stop the number of new hepatitis C cases, that’s how we’ll aim to eliminate and control it,’ she said.
 
‘These are exciting times.’