12 June 2024

Hepatitis C (HCV) is a preventable disease due to the high effectiveness of modern treatments and the potential for early detection and intervention. NSW Health is committed to eliminating hepatitis C as a public health concern by 2028, aligning with the World Health Organisation’s (WHO) goal. Central to this effort is the NSW Hepatitis C Strategy 2022-2025, which outlines the comprehensive approach needed to achieve this significant public health objective.

Bar chart showing hepatitis C cases confirmed, treated and cured for the years 2019, 2020, 2021 and 2022. The chart clearly illustrates the number of confirmed cases is much higher than cases being treated. Of treated cases 93-94% are cured. The numbers off all are decreasing slightly each year.

More than 300 Australians die annually from hepatitis C-related causes. As shown in Figure 1, there has been a 93-to-94 per cent cure rate between 2019 and 2022 from the time an individual received treatment. The high cure rates demonstrate the efficacy of hepatitis C Direct Acting Antivirals (DAAs) treatments. By addressing the gap between ribonucleic acid (RNA) confirmation HCV with DAA treatment uptake, Australia can significantly reduce the burden of hepatitis C moving closer to the 50 per cent elimination goal set by WHO.

 

Screening and diagnosis of hepatitis C

Screening is essential for early detection and treatment effectiveness. Priority populations include:

  • individuals with a history of injecting drugs
  • people in custodial settings or with a history of incarceration
  • those living with individuals who have hepatitis C
  • people with human immunodeficiency virus (HIV) or hepatitis B
  • people from culturally and linguistically diverse backgrounds
  • patients with abnormal liver function tests, acute hepatitis, chronic liver disease or liver cirrhosis
  • those who have had cosmetic surgery or dental treatments overseas

Resources for screening and diagnosis

Decision Making in Hepatitis C Tool
Guides healthcare professionals on diagnosis, treatment and follow-up

Webinar for GPs
Enhances GP understanding of hepatitis C testing and treatment

Project ECHO
Supports GPs in screening, managing, and treating hepatitis C and liver diseases.

Useful Training
Collection of resources categorised by disease area or profession in ASHIM learning hub

 

Hepatitis C treatment

Hepatitis C DAAs allow GPs to prescribe effective treatment with a success rate of approximately 95 per cent. DAAs are included in the Pharmaceutical Benefits Scheme (PBS) and are better tolerated by patients. Treatment is between eight to 12 weeks with one tablet a day with minimal side effects.

Resources for treatment

REACH-C Form
Online tool for GPs for timely specialist approval within 24 hours

PBS Information
Details on hepatitis C medication coverage under PBS

Decision-making Tool for Children
Assists clinicians in managing hepatitis C in children

 

Reducing stigma and discrimination around hepatitis C

Stigma and discrimination significantly hinder treatment access for more than 70 per cent of Australians affected by hepatitis C. These negative attitudes often arise from misconceptions about how the virus is contracted.

To combat this, it is crucial to promote open discussions about liver health and normalise the conversation around hepatitis C. Using inclusive and non-judgmental language fosters a supportive environment, empowering individuals to seek the care they need.

Resources for reducing stigma

The Power of Words: Anti-stigma Guide
Encourages the use of welcoming terms to reduce stigma

 

Effective prevention strategies for hepatitis C

Prevention efforts in primary healthcare settings include:

  • promoting safe injection practices and proper disposal of needles
  • sourcing harm-reduction services such as needle and syringe programs, substance use counselling and opioid treatment programs
  • educating patients and staff about liver health and hepatitis C

Resources for prevention

NSP Locations and Contact Details
Access local needle and syringe program outlets

The NSW Users and AIDS Association (NUAA)
Supports individuals impacted by drug use criminalisation

Opioid Treatment Program (OTP)
Offers methadone, buprenorphine or suboxone treatment

 

Empowering patients: resources for hepatitis C support

Motivate C – Treatment Incentive
Motivate C is an incentivised project conducted by the University of Sydney for newly diagnosed hepatitis C patients. The program aims to find out if an offer of a cash reward will encourage people with hepatitis C to seek treatment from community treatment providers. Participants self-register for this study and will be connected with a treatment navigator to guide them through all study procedures. For further information on Motivate C project email project@sydney.edu.au

Patient Pathway Guide
Provides information on testing and treating hepatitis C

Hepatitis NSW Hotline
Offers support and education

Multicultural HIV and Hepatitis Service (MHAHS)
Works with diverse communities to reduce the impact of viral hepatitis

 

Support from SWSPHN

Keystone practices  

The keystone practices initiative is dedicated to enhancing access to essential treatment for individuals diagnosed with hepatitis C. This project ensures both newly diagnosed and existing patients receive comprehensive care and treatment. 

GPs across South Western Sydney who are unable to provide hepatitis C treatment or support can refer their patients to one of the five specialised keystone practices. These centres are equipped to provide treatment and management, effectively bridging the gap in hepatitis C management. Once the patient has completed treatment, their care is returned to their regular GP. 

For more information and to connect with keystone practices email Rita Colella (LHD Hep C CNC) with the subject: Attention ‘Community Hepatitis C Nurse’.  Alternatively, phone 9794 0855 or 0475 952 636 for all required Hepatitis C questions or support.

 

POLAR walkthroughs  

SWSPHN has developed a set of POLAR walkthroughs to assist healthcare providers in utilising the Hepatitis report and Clinic Summary report. These walkthroughs focus on identifying and managing cohorts associated with hepatitis C.  

By utilising these walkthroughs and reports, practices can better monitor patient populations, streamline diagnosis and optimise treatment pathways for those affected by hepatitis C. 

Helpful walkthroughs: 

Screen capture showing how to find patients using POLAR

 

For more information or support, contact SWSPHN at cqisupport@swsphn.com.au or visit Quality Improvement in Primary Care (QIPC) resources

08 May 2024

Potentially thousands of people in South Western Sydney are living with a disease which is curable – and yet they are unaware of the treatment.

Hepatitis C is a liver infection caused by a virus which is usually transmitted when blood from an infected person enters the bloodstream of another, either from sharing needles or through sexual activity.

Symptoms can include aches, pain and fever; fatigue; nausea or vomiting; loss of appetite; abdominal pain; jaundice (yellow skin and eyes); mood swings, anxiety and depression.

However, most people with hep C don’t experience any symptoms until their liver is irreparably damaged, which can take years.

You are at greater risk of contracting hep C if you received blood or blood products before screening improved in 1993, spent a long time on dialysis or have been infected with HIV.

There is no vaccine to prevent hep C. However, treatment for hep C is now 95 per cent successful.

How common is hep C in South Western Sydney?

In 2020, 0.83 per cent of people in South Western Sydney had hep C, with Campbelltown and Fairfield having the highest rates of disease at 1.18 per cent and 1.01 per cent respectively.

Of that 0.83 per cent – or an estimated 7,669 people – just 42.1 per cent were receiving treatment. 

How does the Motivate C study work?

In a bid to support an Australia-wide initiative to eliminate hep C by 2030, SWSPHN is promoting Motivate C, a Sydney University project which aims to find out if a cash reward will encourage those affected to seek treatment from community providers such as their GP.

The study – known as the Methodical evaluation and Optimisation of Targeted IncentiVes for Accessing Treatment of Early-stage hepatitis C (Motivate C) – is offering payments of up to $1,000 (amount decided by computer algorithm) to participants who commence hep C treatment.

It doesn’t matter if they are newly diagnosed or have had hep C for years.

The only thing which would prevent them taking part in the study would be if they had already started treatment.

Why is treatment important?

Treatment of hep C is important because it helps stop liver damage and might prevent liver cancer.

Current medicines to treat hep C are safe, effective, easy to take with as little as one tablet a day, and available at low cost for people who have a Medicare card because they are subsidised by the Australian government.

Current medicines are very different from older treatments which often resulted in side effects.

What are the benefits of taking part in the study?

As well as the financial incentive, participants receive the help of a “navigator” to connect them to testing and treatment.

Also, the obvious benefit is they will be cured of their hep C infection.

It’s hoped the project will allow even more people to get tested, treated and cured of hep C.

Find out more about Motivate C
05 March 2024

Patients at Tharawal Aboriginal Medical Service now have a clearer picture of how healthy their liver is.

Clinical Nurse Consultant, Irena, from South Western Sydney Local Health District’s Hepatology Service visited the Airds centre on Thursday, 29 February and performed 29 liver fibroscans.

The fibroscan sends a pulse through the liver, a bit like an ultrasound, to measure the stiffness of the liver.

This involves putting a probe between the ribs on the right-hand side of the chest and pushing a button which delivers a vibration into the liver.

Stiffness in the liver indicates scarring.

The higher the score, the more likely the liver has fibrosis or cirrhosis.

  • 5 to 7.4 suggests minimal fibrosis
  • 7.5 to 9.4 suggests moderate fibrosis
  • 9.5 or higher suggests severe fibrosis or cirrhosis

Yearly fibroscans are recommended for patients with abnormal liver function tests.

GPs can refer patients to liver specialists at Liverpool Hospital’s Department of Gastroenterology and Liver for:

  • Fibroscan/Shear Wave Elastography
  • Viral Hepatitis or other Chronic Liver Disease
  • Cirrhosis (compensated/decompensated)
  • Unexplained marked liver function test derangement
  • Hepatocellular carcinoma (suspected or confirmed)

Referral form templates are available here

CAPTION: Irena performs the quick and painless fibroscan on patient Margaret.

05 March 2024

Patients at Tharawal Aboriginal Medical Service now have a clearer picture of how healthy their liver is.

Clinical Nurse Consultant, Irena, from South Western Sydney Local Health District’s Hepatology Service visited the Airds centre on Thursday, 29 February and performed 29 liver fibroscans, just one way of checking your liver’s health.

Read more: Liver Tests Explained

A fibroscan sends a pulse through your liver, a bit like an ultrasound, to measure the stiffness of the liver.

This involves putting a probe between the ribs on the right-hand side of the chest and pushing a button which delivers a vibration into the liver.

Stiffness in the liver indicates scarring (fibrosis).

The higher your score, the more likely your liver has fibrosis or cirrhosis.

  • 5 to 7.4 suggests minimal fibrosis
  • 7.5 to 9.4 suggests moderate fibrosis
  • 9.5 or higher suggests severe fibrosis or cirrhosis

Read more: Fibroscan of The Liver

Yearly fibroscans are recommended for patients with abnormal liver function tests.

Find out more about liver health

CAPTION: Irena performs the quick and painless fibroscan on patient Margaret.

24 July 2023

In the lead-up to World Hepatitis Day on 28 July, SWSPHN has renewed its commitment to the elimination of hepatitis by putting a spotlight on the many hepatitis programs and initiatives we support and endorse.

Our commitment is in line with the WHD 2023’s “We’re not waiting” call to action, and corresponds to an Australia-wide initiative to eliminate hepatitis C by 2030.

With effective treatments available to cure hepatitis C and manage hepatitis B, we encourage at-risk community members to be tested. Tests for hepatitis B and C are not included in standard blood tests and must be requested.

Hepatitis is an inflammation of the liver, commonly caused by a viral infection, and can cause long-term health problems if untreated.

Treatment for hepatitis C, transmitted through blood-to-blood contact, is now 95 per cent successful and there is a vaccine and treatments for hepatitis B.

As part of our undertaking to help eliminate hepatitis, we work with South Western Sydney Local Health District’s Public Health Unit to offer clinics specialising in the care of patients with hepatitis.

We also support Motivate C, a University of Sydney project that aims to find out if an offer of a cash reward will encourage people with hepatitis C to seek treatment by community treatment providers.

Adults with hepatitis C, who haven’t been tested for hepatitis C in the past four weeks, are eligible to take part in the project. Participants self-register for this study and will be connected with a treatment navigator to guide them through all study procedures. All participants are given a compensation payment for their time. Additionally, participants may be randomly assigned to receive a reward payment for starting hepatitis C therapy.

Find out more about Motivate C

Other programs and professionals we work with include:

  • Liverpool Hospital’s Project ECHO clinic supports GPs to screen, manage, and treat your chronic liver disease and viral hepatitis B and C patients.
  • Beyond the C is part of the national hepatitis C project, the 50,000 Project, which aims to find the estimated 50,000 people living with hepatitis C who have not accessed treatment, support or care. The partnership program with general practice hopes to engage these people and connect them with care.
  • ASHM develops and delivers education and training to support the HIV, viral hepatitis and sexual health workforce. ASHM also develops resources to support the HIV, viral hepatitis and sexual health workforce, as well as a series of profession-based booklets for allied health workers and other professionals who may come into contact with blood-borne viruses and sexually transmissible infections.

Talk to your GP about hepatitis B or hepatitis C or call the National Hepatitis Infoline on 1800 437 222 (1800 HEP ABC)

Find out more

28 February 2023

General practices across South Western Sydney are invited to express interest in becoming one of five keystone practices supporting hepatitis C care in our region.

The pilot project is part of a two-year program to support primary care-led treatment of positive hepatitis C cases.

Participating practices are eligible to receive up to a total of $20,000, including:

  • An initial sign-on payment of $2,750 for participating practices
  • $150 per patient who has hepatitis C treatment initiated (currently limited to 115 patients maximum)

Patients from practices who do not offer hepatitis C treatment and patients who do not have a regular general practice, will be referred to the keystone practices. Clinical support will be available for participating practices.

Practices interested in applying should complete this:

Expression of Interest (EOI)

Applications are due by 5pm on Friday, 24 March 2023.

Please contact alyssa.horgan@swsphn.com.au with any questions.

21 April 2022

The first step to living a healthy life with HIV and hepatitis C is to get tested. HIV and hepatitis C are treatable health conditions.

If you want to get tested for HIV and/or Hep C and stay anonymous, the dried blood spot (DBS) test is a new, free, easy and private way to test for HIV and hepatitis C.

Just take a few drops of blood from your finger, mail the test back and get your results by phone, text or email.

You don’t need to go to a clinic or see a doctor to do this test.

For more information, to check your eligibility or to get a test sent out to you: 

Home – HIV and Hepatitis C Dried Blood Spot Test (nsw.gov.au)

 

Downloadable resources:

Infographic for print

Infographic for web

A3 poster

A4 poster

Business card

02 March 2020

Did you know that NSW Health’s Hepatitis B Strategy calls for every pregnant woman to be tested for hepatitis B?

For women diagnosed within antenatal screening, a positive result can be pretty alarming, with issues around:

  • feeling dirty and contaminated,
  • worrying about transmission to baby and to other family,
  • wondering about source of infection (hepatitis B is considered an STI and a diagnosis can raise uncertainty around fidelity within intimate relationships).

In addition, a large proportion of diagnosed women are from culturally and linguistically diverse backgrounds and possibly not highly health literate or comfortable within the NSW healthcare system and environment.

Hepatitis NSW has developed a pamphlet that aims to help address the needs of women diagnosed within antenatal screening.

It was developed with valuable input from Caroline Homer, Professor of Midwifery, University of Technology Sydney, and Hannah Dahlen, Professor of Midwifery, Western Sydney University.

Hepatitis NSW can provide antenatal-related health workers with an ongoing free supply of Hepatitis B, Mothers and Babies. To order your free supply, email pharvey@hep.org.au

04 February 2020

SWSPHN recently notified Medicare of hepatitis C virus (HCV) screening rate increases in general practices across South Western Sydney as a result of our collaboration with the South Western Sydney Local Health District (SWSLHD) on the Viral Hepatitis C Clinical Nurse Consultant project.

Direct acting antivirals (DAAs), available since 2016, have changed the landscape of treatment options for people living with HCV. GP prescribing of HCV treatment has the potential to expand the treatment workforce and increase accessibility to clients.

The collaboration aims to increase treatment uptake by people with HCV within the general practice setting. It is a supportive model which enables GPs and practice nurses to consult with a Viral Hepatitis CNC for care coordination of clients with HCV.

The project is contributing to benefits of HCV treatment including; financial benefit for the health system; upskilling GPs and practice nurses; engages people with HCV in primary care settings; engages in ‘Close the Gap’ campaign and strengthens trust among Aboriginal communities; increased screening and treating contribute to Ministry of Health targets and elimination strategies.

If you would like further information, please contact Katherine McQuillan, Community Hepatitis C CNC, HIV and Targeted Programs, on 0436 819 237 or via email at Katherine.McQuillan@health.nsw.gov.au