Rethinking Australia’s hepatitis strategy: World Hepatitis Day

Coinciding with World Hepatitis Day, a new analysis by Hepatitis Australia reveals the face of hepatitis in Australia is changing and the healthcare sector must adapt, fast.

Despite major advances in treatment and prevention, hepatitis B and C remain the leading causes of liver cancer both globally and in Australia. These viruses are responsible for 90% of liver-related deaths, and liver cancer mortality continues to rise faster than any other cancer in the country.

“It’s a serious concern that nearly 300,000 people in Australia live with hepatitis B and C and nearly 1,000 Australians die each year from these preventable diseases,” said Hepatitis Australia CEO Lucy Clynes. “There is a simple cure for hepatitis C and treatment for hepatitis B, but many people aren’t receiving them because they’re unaware of their risk or disconnected from care.”

Hepatitis Australia’s new report, If Hepatitis Was 100 People, points to urgent issues: many Australians remain unaware of their risk, one in three people with hepatitis B don’t realise they have it, and far too many are missing out on life-saving care.

Professor Joseph Doyle, Hepatitis Australia President and an infectious diseases expert, stressed that while testing is straightforward, symptoms are often invisible until serious liver damage has occurred.

“Point-of-Care testing [dried blood spot (DBS)] in particular adds another tool to our kit, and is a game changer for people living with, or at risk of hep C. It makes testing, diagnosis and treatment initiation easier, more accessible and less time consuming. Most importantly, it means people can start their journey to cure sooner,” said Hepatitis NSW CEO Associate Professor Steven Drew.

DBS testing allows people to collect a few drops of blood from a finger at home and send the sample in for analysis – offering a free, accurate alternative that eliminates the need for a doctor visit. For some, conventional lab testing may still be more suitable.

Current frontline therapies include Gilead’s Epclusa (sofosbuvir/velpatasvir) and AbbVie’s Maviret (glecaprevir/pibrentasvir) for hepatitis C, with Vosevi (sofosbuvir/velpatasvir/voxilaprevir) used as salvage therapy where primary therapy was unsuccessful. For hepatitis B, BMS’s Baraclude (entecavir) and Gilead’s Viread (tenofovir) remain effective treatments, with tenofovir plus lamivudine used in lamivudine-resistant patients, in line with Gastroenterological Society of Australia (GESA) guidelines.

Yet, barriers persist in reaching those living with hepatitis, particularly as the affected population evolves. According to Hepatitis Australia, 84% of people living with hepatitis C in Australia no longer inject drugs or contracted hepatitis C in other ways. That could be things like unsafe tattooing, receiving a blood transfusion before 1990 or getting a medical or dental procedure in a country with poor blood safety regulations.

“They are less likely to be interacting with services where hepatitis C is core business. We need to find new ways to reach them,” said Clynes.

First Nations communities also continue to be disproportionately impacted. Dr Megan Campbell, Medical Advisor at NACCHO, said “Aboriginal and Torres Strait Islander peoples now make up 18% of people living with hepatitis C in Australia. This figure is rising as Aboriginal and Torres Strait Islander people do not equitably benefit from new hepatitis C cures and are disproportionately more likely to be reinfected. The diagnosis rate among Aboriginal and Torres Strait Islander people is more than six times higher than the national average.”

While there is no cure yet for hepatitis B, effective treatment significantly reduces the risk of liver disease and cancer. Yet, awareness remains lower than expected.

“Nearly 220,000 people in Australia are living with hepatitis B, but less than 25% are receiving regular care. Almost half of all people with chronic hepatitis B have not received care at any time in the last 10 years,” said Clynes. “Our analysis shows that more than half of all people living with hepatitis B might need information in languages other than English and support in culturally sensitive ways.”

Dr Campbell noted, “With hepatitis B, the story is similar; Aboriginal and Torres Strait Islander people represent 7% of people living with chronic hepatitis B but are less likely to have accessed care and treatment. Despite high childhood vaccination rates, many adults who aren’t immune have limited access to vaccination.”

One successful intervention is the Hep B PAST program in the Northern Territory, which has doubled treatment rates among Aboriginal and Torres Strait Islander people compared to the national average.

“Community leadership works; it just needs backing,” added Dr Campbell.

Vaccination has protected people born in Australia since 2000, but those born earlier or overseas remain vulnerable, often unknowingly. Symptoms frequently appear only once liver damage is severe.

“Pregnancy is also a key time when parents with hepatitis B are diagnosed, and we need to ensure that the whole family is getting the care they need to live long and healthy lives. Nearly one in 20 babies born to mothers with hepatitis B are not receiving the vaccine in time. We need to strengthen the monitoring of the hepatitis B ‘birthdose’ vaccine [H-B-Vax II Paediatric or Engerix B Paediatric],” Clynes said.

NACCHO Chair Donnella Mills emphasised, “As a country, we can’t claim progress if the most affected communities are still missing out. The way forward is in our hands, and with real commitment, we can end viral hepatitis for everyone, leaving no one behind.”

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