8th Annual Conference of Australian Society for HIV Medicine (ASHM) 2006, Melbourne 11-14 October 2006
Hepatitis C treatment uptake in Australia is generally low. In this paper we describe the rate of acute hepatitis C treatment in Victoria by linking the passive notifications by doctors and clinicians to the Department of Human Services (DHS) with the Australian Trial in Acute Hepatitis C (ATAHC) clinical trial in acute hepatitis C treatment.
ATAHC is a nationwide clinical trial aimed at providing people with newly acquired HCV with pegylated interferon treatment.
Subjects are eligible if they have seroconversion from negative to positive anti-HCV antibody within 24 months, or acute clinical hepatitis C and are enrolled within 6 months of anti-HCV antibody positive result. Patients are being recruited through referral from clinics and general practitioners.
We aimed to increase the recruitment of eligible participants to the ATAHC study through the Victorian HCV enhanced surveillance system.
In the first 18 months of this study (May 2004 - November 2005), 4591 HCV cases were notified to DHS (crude population rate 61/100000); 414 (9%) of these were flagged as being potentially newly acquired (rate of 5.5/100000) and referred to Burnet for enhanced surveillance.
Through follow-up of doctors and patients, 160 of these were confirmed as newly acquired (crude annual rate 2.1/100000); 87 of these 160 (54%) were potentially eligible for ATAHC (rate 1.2/100000) and were referred to ATAHC researchers.
Fourteen (16%) were successfully enrolled in ATAHC (rate 0.18/100000) and seven had commenced on hepatitis C treatment by November 2005.(population rate 0.09/100000). Thus the crude rate of untreated but eligible acute hepatitis C was substantial higher than that of treated acute hepatitis C (1.11/100000 vs 0.09/100000).
This gives a uptake proportion of eligible candidates of 7.5%, and a proportion of the total confirmed newly acquired hepatitis C cases receiving acute treatment in Victoria of 4.3%. A clear limitation is that these figures only refer to the tested Victorian population.
The use of hepatitis C surveillance system has been successful in identifying cases of newly acquired HCV which are often difficult to identify in a clinical setting.
In addition, marginalised patients who may otherwise never have been referred to a clinic are able to access HCV treatment and specialist services.
Despite this, only 7 out of 87 eligible individuals (8%) began acute hepatitis C treatment.