National report paints worrying picture for hepatitis B

The number of Aussies engaged in treatment or monitoring fell behind targets in 2021.

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Australia is lagging behind treatment targets for hepatitis B, new data from a national mapping project has revealed.

But a suite of new resources has been published to support GPs at the time of diagnosis to refer patients on to community s100 prescribers, with the aim of reaching future targets.

Treatment uptake for people with hepatitis B in 2021 was just 12.7%, well below the National Hepatitis B Strategy 2018–2022 target of 20% by the end of 2022.

And the number of people engaged in either treatment or monitoring (26%) also fell well short of the strategy’s target of 50% by the end of 2022.

The latest Viral Hepatitis Mapping Project: Hepatitis B report covers data collected in 2021, and is part of an ongoing initiative of the WHO Collaborating Centre for Viral Hepatitis Epidemiology, the Doherty Institute and ASHM.

The report found an estimated 200,000 people were living with chronic hepatitis B in Australia, representing 0.78% of the total population.  Of these, about 55,000 remained undiagnosed.

The proportion of the population living with the condition varied widely across Australian PHNs and was highest in Northern Territory (1.73% of the population) and in PHNs in South Western Sydney (1.32%), Western Sydney (1.24%), Central and Eastern Sydney (1.2%), Northen Sydney (1.14%), Eastern Melbourne (1.11%) and North Western Melbourne (1.08%).

PHNs with the lowest proportion of the population living with chronic hepatitis B included Tasmania (0.27%), Country South Australia (0.32%), Gippsland (0.33%), Western Victoria (0.35%) and Central QLD, Wide Bay, Sunshine Coast (0.35%).

Although the number of people receiving treatment has increased over time, the rate of increase has reduced in recent years. Treatment uptake was highest in PHNs in Sydney, Melbourne, and Brisbane, as well as Australian Capital Territory, a trend that continued for the proportion of people with the infection who received care (treatment or monitoring).

General practitioner prescribing was stable in 2021, and 22.2% of people treated for chronic hepatitis B in 2020 had a GP prescribe at least one of their prescriptions. This included more than 2000 people who had all their prescriptions provided by a GP, while the remainder were prescribed prescriptions by both a GP and a specialist physician and/or other provider.

ASHM CEO Alexis Apostolellis said the findings demonstrated the importance of considering all pathways to treatment for people living with hepatitis B.

“Despite the fact that a lot of people being treated for hepatitis B can be managed exclusively in primary care, only about 10% are,” he said.

“Not only are community s100 prescribers an underutilised resource for hepatitis B care, we also know patients in primary care typically receive faster treatment, are less prone to disconnect from health services and are more likely to adhere to treatment regimes.”

To coincide with the release of the research, ASHM has published a range of resources to support clinicians at the time of diagnosis to refer patients on to community s100 prescribers.

The resources, launched as part of the ‘Hep B care. It’s primary care, too.’ campaign provide guidance for diagnosing clinicians, including a map to find local primary care prescribers of specialised hepatitis B medicine, and practical clinical communications tools to support the referral.

Dr Jill Benson, a hepatitis B s100 community prescribing doctor working in remote communities in Western Australia, said treating hepatitis B in primary care was a practical way to improve access for patients.

“Many people with hepatitis B have challenges accessing tertiary care, sometimes due to geography, but also due to cultural and social barriers,” she said.

“These are people we know well as primary care practitioners. They trust us, we ensure continuity of care, and we are usually easier for them to access.

“Caring for someone in their own community means they do not have to travel, can have local support and ask all the ‘silly questions’ they don’t feel comfortable asking an unknown doctor.”

The report also found the number of people engaged in monitoring (received a viral load test while not receiving antiviral treatment) dropped in 2020 and in 2021, impeding progress toward the care uptake target. GPs provided almost half of all monitoring tests in 2021, according to the report.

The news around immunisation was concerning – timely infant hepatitis B immunisation uptake (measured at 12 months of age) nationally declined to 94.6% in 2021, below the 95% National Strategy 2018–2022 target for 2022, despite the target previously having been met. Immunisation coverage was lower among Aboriginal and Torres Strait Islander children (91.8%), and this also declined between 2020 and 2021.

The 95% coverage target was met in 16 of Australia’s 31 PHNs for all children, and in eight PHNs for Aboriginal and Torres Strait Islander children.