Joseph S Doyle1,2, Nick Scott2,3, Rachel Sacks-Davis2, Alisa E Pedrana2,3, Alexander J Thompson4,5, Margaret E Hellard1,2,3. 1. Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia. 2. Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia. 3. School of Population Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia. 4. Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia. 5. Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.
Abstract
BACKGROUND: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. AIM: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. METHODS: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. RESULTS: In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. CONCLUSIONS: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.
BACKGROUND: Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. AIM: To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. METHODS: We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. RESULTS: In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. CONCLUSIONS: Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.
Authors: Margaret Hellard; Sophia E Schroeder; Alisa Pedrana; Joseph Doyle; Campbell Aitken Journal: Cold Spring Harb Perspect Med Date: 2020-04-01 Impact factor: 6.915
Authors: Michael W Traeger; Alisa E Pedrana; Daniela K van Santen; Joseph S Doyle; Jessica Howell; Alexander J Thompson; Carol El-Hayek; Jason Asselin; Victoria Polkinghorne; Dean Membrey; Fran Bramwell; Allison Carter; Rebecca Guy; Mark A Stoové; Margaret E Hellard Journal: PLoS One Date: 2020-06-30 Impact factor: 3.240
Authors: Sophia E Schröeder; Alisa Pedrana; Nick Scott; David Wilson; Christian Kuschel; Lisa Aufegger; Rifat Atun; Ricardo Baptista-Leite; Maia Butsashvili; Manal El-Sayed; Aneley Getahun; Saeed Hamid; Radi Hammad; Ellen 't Hoen; Sharon J Hutchinson; Jeffrey V Lazarus; Olufunmilayo Lesi; Wangsheng Li; Rosmawati Binti Mohamed; Sigurdur Olafsson; Raquel Peck; Annette H Sohn; Mark Sonderup; Catherine W Spearman; Tracy Swan; Mark Thursz; Tim Walker; Margaret Hellard; Jessica Howell Journal: Liver Int Date: 2019-09-04 Impact factor: 5.828
Authors: Daniel O'Keefe; J Gunn; Kathleen Ryan; Filip Djordjevic; Phoebe Kerr; Judy Gold; Imogen Elsum; Chloe Layton; Kico Chan; Paul Dietze; Peter Higgs; Joseph Doyle; Mark A Stoové; Margaret Hellard; A E Pedrana Journal: BMJ Open Date: 2022-01-04 Impact factor: 2.692
Authors: Anna Lee Wilkinson; Alisa Pedrana; Michael W Traeger; Jason Asselin; Carol El-Hayek; Long Nguyen; Victoria Polkinghorne; Joseph S Doyle; Alexander J Thompson; Jessica Howell; Nick Scott; Wayne Dimech; Rebecca Guy; Margaret Hellard; Mark Stoové Journal: Epidemiol Infect Date: 2021-12-06 Impact factor: 2.451
Authors: Dr Nick Scott; Ms Anna Palmer; Mr Tom Tidhar; Prof Mark Stoove; Dr Rachel S Sacks-Davis; A/Prof Joseph S Doyle; Dr Alisa J Pedrana; Prof Alexander Thompson; Prof David P Wilson; Prof Margaret Hellard Journal: Lancet Reg Health West Pac Date: 2021-11-23
Authors: Arpan A Patel; Aileen Bui; Eian Prohl; Debika Bhattacharya; Su Wang; Andrea D Branch; Ponni V Perumalswami Journal: Hepatol Commun Date: 2020-12-07