Theme: Epidemiology & Public Health Research Year: 2019
Background:
Scaling up testing is fundamental to Australia achieving hepatitis C elimination goals. We describe
patterns of hepatitis C virus antibody (HCV Ab) testing in primary care prior to and following the
listing of Direct Acting Antivirals (DAAs) on the pharmaceutical benefits scheme (PBS).
Methods:
Clinical consultations, HCV Ab test and results collated by the Australian Collaboration for Enhanced
Sentinel Surveillance (ACCESS) from 32 primary care sites across Australia. Individuals contributed
one consult, one test and one result per quarter. Segmented regression assessed trends in HCV Ab
testing and positivity pre-DAAs (Q1 2009–Q1 2016) and post-DAAs (Q2 2016-Q2 2018) PBS listing.
Analysis were stratified by clinic type: gay and bisexual men (GBM)-focussed, people who inject
drugs (PWID)-focussed and ‘Other’ community health and general practice sites (clinics without a
specific priority population focus).
Results:
In total, 3,558,761 consults were included, 43.8% from GBM, 28.9% from PWID, and 27.3% from
other clinics. A total of 185,211 HCV Ab tests were included and 8.5, 3.2 and 2.0% of total consults
included a HCV Ab test at GBM, PWID and other clinics, respectively. At GBM clinics, there was an
increasing trend in HCV Ab testing pre-DAAs, which continued post-DAAs (246 tests/quarter,
95%CI:182-310), with an overall positivity of 2.4%, which has stabilised since March 2016 (-0.04%,
95%CI:-0.08, 0.005). At PWID and other clinics, Ab testing trends increased pre-DAAs and have since
plateaued (PWID:1.8 tests/quarter, 95%CI:-14,17; Other:4.0 test/quarter, 95%CI:-7,15). Overall
positivity remained high among PWID clinics (14.4%) and has increased since March 2016 (0.45%,
95%CI:-0.12,1.01) compared to Other clinics where positivity was lower 3.8%, and has stabilised
since March 2016 (-0.04, 95%CI:-0.24, 0.16).
Conclusion:
Improving testing coverage among priority populations is an important step for Australia to achieve
hepatitis C elimination, while monitoring trends in HCV Ab positivity can inform efforts to identify
new infections.
Disclosure of Interest Statement: none