Modelling for evidence-based national hepatitis B testing plans

In 2018, approximately 230,000 people in Australia were living with chronic hepatitis B, but only an estimated 68 percent were diagnosed, highlighting the needs for increasing hepatitis B testing and diagnosis. The Australian Government’s 3rd National hepatitis B Strategy set the target of 80 percent of people with chronic hepatitis B to be diagnosed by 2022.

Objective

Current hepatitis B testing practice is voluntary testing promoted by symptoms or risk assessment, with mandatory testing in some conditions (such as blood donation). However, there are missed opportunities for hepatitis B testing.

Overseas born migrants are assessed against health requirements at immigration medical examination; if the cost exceeds a threshold, then the likelihood of the visa application being rejected is high. From July 2019, the threshold was increased to AUD$49,000 over a ten-year time span.

This new threshold means that most applicants living with chronic hepatitis B will remain eligible, even if taking hepatitis B treatment. This change posed an opportunity to assess the approach of providing hepatitis B tests to potential new migrants from endemic countries to ensure people are diagnosed as early as possible and ensure timely linkage to care.

Timeline

2019–2021.

Approach

This project aimed to assess strategies of:

1. a general population testing approach, i.e. offering a test to every individual in an eligible group, usually defined by age or could be anyone presents to a GP
2. a hepatitis B testing program for new migrants in Australia.