Hepatitis Awareness Week 26 July –1 August 2021

26 July 2021

Hepatitis Awareness Week 26 July – 1 August

Hepatitis Can’t Wait.

Despite the ongoing COVID-related difficulties of the past year we need to continue to work towards hepatitis elimination by 2028 in NSW. 

It is an achievable goal with GPs playing a very key role. World Hepatitis Day is on 28 July each year and aims to raise awareness of viral hepatitis, increase hepatitis screening and treatment, in order to prevent cirrhosis and hepatocellular cancer.

This year’s theme Hepatitis Can’t Wait conveys the urgency of efforts needed to eliminate hepatitis as a public health threat.

Increasing screening, diagnoses of hepatitis C (HCV) and hepatitis B (HBV) and the prescribing of antiviral treatment in GP settings is essential.

Antiviral treatment prescribed by GPs is suitable for the majority (around 90%) of people living with HCV, in particular those with mild–moderate liver fibrosis - yet only about 40% of the total number of DAA scripts are written by GPs.

CESPHN, the local LHDs and NSW Health are strongly supportive of GPs prescribing HCV treatment and can offer support, education, and guidance. This aligns with the Central and Eastern Sydney PHN Hepatitis Strategy 2021-2025.

CESPHN and partners have developed an easy Quality Improvement Activity(QIA) around testing for Hepatitis C, and can be found here, using the screening checklist for reception found here.  

CESPHN is also happy to tailor any HBV or HVC activity to suit your practice and demographics, with support from our local Liver Clinics.

While in recent years there has been a focus on HCV elimination, the reminder of this article will focus on HBV.

HBV

It is estimated that 1 in 3 people living with HBV in Australia are undiagnosed and are therefore not receiving recommended HBV care. Without appropriate monitoring or treatment, up to 1 in 4 people with HBV could die from liver cancer or liver failure.

Evidence suggests appropriate treatment for chronic hepatitis B (CHB) can reduce the risk of liver cancer by more than 50%. Our PHN has one of the highest prevalence of HBV in Australia. It is highly recommended that all patients from priority CALD communities (Asia Pacific region, Eastern Europe, Africa, and the Middle East) be tested at least once for HBsAg, anti‑HBc and anti-HBs to establish whether they have chronic hepatitis B, are immune through past infection or vaccination, or are susceptible to infection.

All people with chronic hepatitis B require regular (6 - 12 monthly) monitoring of hepatitis B viral load and should be receiving ongoing care, incorporating either yearly off-treatment monitoring (including a DNA viral load test) or antiviral treatment.

The frequency of Hepatocellular carcinoma (HCC) surveillance (ultrasound and AFP) varies according to age, sex, the extent of liver damage and family history of HCC and/or other complicating factors. GPs are ideally suited to ensure patients engage in monitoring and surveillance. Liver clinics and liver specialists are happy to consult about patients with hepatitis B, assess the extent of their liver disease and provide advice on long-term care. Patients also have the opportunity to participate in clinical trials of new treatments for hepatitis B. The goals of these clinical trials is to develop finite therapies so that patients do not require lifelong antiviral treatment.

Medicare data since 2018 reveals a concerning decrease in the number who are having regular HBV DNA monitoring across all LHDs in NSW.

The Figure below shows a 20% decrease in HBV viral load testing since 2018. This may reflect a similar decrease in HCC surveillance.

Screen Shot 2021 07 26 at 4.49.28 pm

Data source: Medicare Benefits Schedule, Department of Human Services.

Figure 1. Number of people in the five high prevalence LHDs with CHB and not receiving treatment who had a HBV DNA viral load test via Medicare, 1 January 2018 – 31 December 2020.

For more information on screening, testing and treatment, GPs and other health professionals can access more information via their respective HBV HealthPathways site:

South Eastern Sydney (covers inner city, eastern and southern suburbs including St George and Sutherland Shire) - https://sesydney.communityhealthpathways.org

Sydney (covers central Sydney and the Inner west) - https://sydney.communityhealthpathways.org/

Some GPs in the CESPHN region have embraced HBV prescribing. Click here for more information.

In both SLHD and SESLHD, hospital and community medical, nursing and health promotion teams are keen to support GP HBV screening, case management and prescribing.  

For more information, please contact CESPHN’s Viral Hepatitis team on; sexualhealth@cesphn.com.au