CASE STUDY

Hepatitis C Notification Rates and Treatment Uptake

Outline of the research

The World Health Organisation has established Hepatitis C virus (HCV) elimination targets, proposing an 80% reduction in HCV incidence, and a 65% reduction in HCV-related mortality by 2030. While these are ambitious targets, they remain achievable in Australia, due to the introduction of unrestricted access to direct-acting antivirals for all HCV-infected people, irrespective of disease stage, treatment history, or drug use status. Nonetheless, there are still substantial barriers to the uptake of DAA, particularly for people who inject drugs (PWID – the highest at-risk group for HCV transmission in Australia). Many of these barriers relate to health service access, and identifying the key characteristics of high-priority regions is essential to inform the distribution and the implementation of programs to find, link and retain people in care. Until recently, little work had been done on this topic.

Dr. Nick Scott and Samuel Hainsworth of the Burnet Institute, and their colleagues Professor Paul Dietze, Dr. Rachel Sacks-Davis, Dr. Alisa Pedrana, Dr. Joseph Doyle, Dr. Amanda Wade, Professor David Wilson, and Professor Margaret Hellard tackled these gaps by focussing on two main research questions. What is the relationship between the socio-economic/demographic characteristics and health service coverage of geographic areas across Australia and [1] HCV notification rates (using local government areas – LGAs); and [2] HCV treatment prescribing and uptake (using Statistical Area 3 – SA3s).

How AURIN was used

One of the key suites of variables that the researchers included in their analysis was access to health services, such as the number of GP services, number of alcohol and drug services, number of hospitals, and the number of liver specialists within geographic areas. These variables were sourced from the National Health Services Directory (NHSD), provided for free use by academic and government researchers through the AURIN Portal by Health Direct. The NHSD is a comprehensive, nationwide dataset providing the point-level location of every health provider in Australia, ranging from Child and Maternity Services, through to tertiary care.

Hepatitis C Virus Electron Micrograph. Source: Wikimedia Commons (https://upload.wikimedia.org/wikipedia/commons/3/3b/HCV_EM_picture_2.png)

The AURIN database was easy to use, clean and comprehensive. It provided access to variables that would have been challenging or impossible to model otherwise. Without the AURIN database we would not have been able to generate evidence to support a geographically targeted response to HCV.

– Dr Nick Scott

Findings and Impacts of the Research

Dr. Scott and Mr. Hainsworth and their colleagues showed that HCV notification rates were higher in LGAs with higher numbers of needle and syringe programs, higher alcohol and drug services, and higher levels of socio-economic disadvantage. They also showed that unmet demand for health services were higher in geographic areas outside of major metropolitan areas, which included a disproportionate number of socio-economic decile 1 and 2 LGAs (most disadvantaged) relative to population size. 

By contrast, DAA treatment uptake was highest in geographic areas within major metropolitan regions, areas with lower socio-economic disadvantage, and areas with lower proportions of overseas-born residents.

These results suggest that there is a disconnect between the areas where HCV infections may be occurring and the areas where treatment rates are highest. In particular, areas of socio-economic disadvantage and areas with a higher proportion of the population born overseas may need targeting with interventions to improve treatment uptake. This is now the focus of the EC Australia partnership; an AUD11.33 million project, funded by the Paul Ramsay Foundation, to bring together researchers, scientists, government, health services and community organisations to deliver a coordinated national response to HCV.

[1] Hainsworth, S. W., Dietze, P. M., Wilson, D. P., Sutton, B., Hellard, M. E., & Scott, N. (2018). Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas. PloS one13(6), e0198336.

[2] Scott, N., Hainsworth, S. W., Sacks-Davis, R., Pedrana, A., Doyle, J., Wade, A., & Hellard, M. (2018). Heterogeneity in hepatitis C treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access. Journal of Virus Eradication4(2), 108.