HEPATITIS C VIRUS ELIMINATION PROGRESS IN A SETTING OF HIGH HARM REDUCTION COVERAGE: AUSTRALIA ON-TRACK

Jason Grebely, Gregory Dore

Background: Direct acting antiviral (DAA) therapy has transformed chronic HCV management. WHO has established HCV elimination goals for 2030, including reductions in HCV incidence of 80% and HCV liver-related deaths of 65%.
Methods: DAA therapy has been available in Australia since March 2016, through a Federal Government-funded program of unrestricted access, with no restrictions based on alcohol or drug use, liver disease stage, and with all medical practitioners able to prescribe. Australia has a comprehensive program of HCV elimination monitoring and evaluation. Key projects include an Annual Needle Syringe Program Survey (ANSPS), which enrolls 2,000-2,500 people who inject drugs (PWID) through a large network of Needle Syringe Program (NSP) sites, an observational cohort of HIV/HCV co-infected individuals (CEASE, n=380), and HCV notification data linkage projects, including in New South Wales (n=96,000).
Results: By end 2017, 58,480 people had received DAA therapy (26% of estimated 227,000 with chronic HCV). DAA uptake was high among PWID, with 41% reporting ever received HCV treatment by October 2017, and HCV RNA prevalence (based on ANSPS dried-blood sample testing) declining from 45% in 2015 to 25% in 2017. DAA uptake was even higher among HIV/HCV co-infected, at 80-90% and estimated HCV RNA prevalence among people living with HIV (PLWH) declined from 10% to 1-2% from 2015 to 2018. The burden of HCV-related advanced liver disease has declined, with reductions in hospitalizations for decompensated cirrhosis and hepatocellular carcinoma, and liver-related deaths. Mathematical modelling indicates that WHO elimination goals will be achieved, even with declining treatment rates.
Conclusion: In a setting with high harm-reduction coverage, Australia has demonstrated encouraging progress towards achieving WHO elimination goals. High-risk populations, including PWID and PLWH have been priority populations for DAA access. Innovative programs for DAA delivery to marginalized PWID are being developed, including peer-based support for NSP setting treatment.