A Partnership Approach To Implementing An Elimination Program For Hepatitis C: A Story From Down Under.

Author: Pedrana A, Doyle J, Stoove M, Richmond J, Gold J, Dietze P, Higgs P, Scott N, Howell J, McBryde E, Sievert W, Petrie D, Vickerman P, DiGiacomo D, Eagle M, Kelsall J, Thompson A, Hellard M

Theme: Epidemiology & Public Health Research Year: 2017

Background: Modelling suggests WHO targets for hepatitis C virus (HCV) elimination by 2030 can be achieved if treatments are targeted towards people who inject drugs (PWID). In Australia, universal access to direct-acting antivirals (DAAs) for all patients chronically infected removes key policy impediments making elimination targets achievable. However, to achieve these targets a major shift from tertiary- to community-based services is required to reach and treat PWID. This shift requires an integrated approach from providers, policy makers, community organisations and drug user networks.

Methods: The ‘Eliminate Hepatitis C (EC) Partnership’ is implementing an elimination program utilising a health systems framework, delivered through five key components; health promotion and demand generation activities, training and education, clinical pathways, data systems and surveillance and research and evaluation (including financing), with a governance structure to provide leadership and strategic direction. Community-integrated hepatitis C nurses are central to achieving the population coverage needed to realise elimination targets by providing support and outreach services within high-caseload community sites and prisons. The scale-up of key interventions, including rapid point-of-care testing and pharmacy-led treatment will ensure enough treatment demand for treatment-as-prevention to be effective and sustainable. A surveillance system will allow ongoing monitoring and assessment of achieving elimination targets.

Results: Between 2017-2021, the EC Partnership will provide tailored support to 28 community and prison services, to maximise the quality, efficiency and uptake of HCV treatment among PWID. Treating a minimum of 4500 PWID with HCV over a three-year period will provide meaningful reductions in community prevalence (21%) and incidence (12%). If successful this approach will enable the State of Victoria to meet WHO’s 2030 elimination targets.

Conclusion: Australia is uniquely placed to demonstrate impact of an innovative model that will strengthen local health systems and provide real-world evidence for HCV elimination aspirations.

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