Latest National Mapping Report highlights
7 June 2019
The Doherty Institute’s viral hepatitis National Mapping Report 2017 was published in April, providing an Australia-wide snapshot of prevalence, treatment and progress for hepatitis B, hepatitis C, and for liver cancer.
In a podcast interview with Hepatitis Victoria, Jennifer MacLachlan, Epidemiologist at the Doherty Institute said there were some surprising revelations, but first explained the decision to combine what were previously separate reports, and to add new data related to liver cancer.
” At a time when we are making progress with hepatitis C through new mediations, we want to make sure hepatitis B doesn’t fall behind -in other words lose focus on one area at the expense of another,” Jennifer said, hence the combined and expanded report.
“The overall focus is on tackling viral hepatitis as essentially one thing, and to do this it is good to have everything in one place,” she said.
But gathering such vital data was complex and slow, and included discussions with local health experts in some areas to tease out the evidence, explain or challenge anomalies. Jennifer said it’s was a process that “…takes time and but delivers”.
So, what are some of the highlights?
“For hepatitis C, we saw great uptake for the new treatments when they became available in 2016, and in 2017 uptake has stabilised at a steady rate. It’s a decline but one that is consistent nationwide.
Poor uptake of hepatitis C cures in some rural and regional areas a worrying trend
“The good news is that current levels of treatment still give hope that we are going to achieve the elimination goals of 2030, but there are some places in Australia which are falling behind, making success in those areas less likely,” Jennifer said.
“It’s clear that miracle drugs are not enough if people don’t know they are living with a condition or know but not cognizant of the long-term effects of avoiding treatment.
“We have to make sure we are reaching out to those communities and making sure they are getting service delivery,” she said.
Prisons are also an important nexus of hepatitis C and a special section of the report is devoted to uptake data from inside.
Jennifer said that for hepatitis B, one of the biggest challenges is that priority populations vary greatly according to area, for example, 60% of people living with hepatitis B in the Northern Territories are Aboriginal and Torres Straight Islanders, while the majority in urban Melbourne were born overseas.
“This underscores the fact that if we are going to respond to hepatitis B effectively, we need to tailor the messages precisely to the groups affected,” she said
For hepatitis B and cancer, Jennifer said it is clear there is a stark correlation between both diseases where there is a high prevalence of hepatitis B.
Gaps in the cascade of care for hepatitis B
Perhaps the biggest revelation from the report is in the hepatitis B cascade of care, where fewer people than previously thought are receiving ongoing care.
“People living with hepatitis B are falling through the cracks in terms of regular follow up – although 20% of people living with CHB had a viral load in 2017, the majority of those people only had one every three to four years, while guidelines recommend yearly monitoring is important to identify if people need treatment, and irregular follow up puts people at risk of adverse outcomes." Jennifer said.
There needs to be more thought on what is causing this serious situation and how it should be tackled.
Key deliverables from the report include the need for closer monitoring of the cascade of care, looking at how well people are being followed up by their health professionals, and investment in effective awareness campaigns for the public as “…chronic disease is challenging, and it is difficult to remain focused.”
“We can also see for the first time some of the disparities in liver cancer incidence by geographic area, and these insights are extremely valuable when it comes to informing policy and health approaches,” Jennifer said.
For the next report Jennifer said she and her team at the Doherty want to look further at liver cancer geographically, and to “…make sure the data we are publishing is timely and that we are tracking in an up to date way how we are progressing.”