Hepatitis C

Viral Hepatitis Forum – What’s the Evidence

The Department of Health and Ageing sponsored a Viral Hepatitis Forum during Hepatitis Awareness Week 2008. The Forum featured presentations by experts in the field of viral hepatitis and a panel discussion.

World Hepatitis Day – An Overview

The first global World Hepatitis Day was conducted on the 19 May 2008 in response to the worldwide hepatitis epidemic. It is a day dedicated to raising awareness, changing perceptions of people worldwide and obtaining support from governments across the world. Hepatitis Awareness Week ran from 19-23 May 2008. 5th and Final Australian World Hepatitis Day Newsletter for 2008 (PDF 589 KB) is available on the Hepatitis Australia website.

Viral hepatitis presents a significant challenge globally with 500 million, or 1 in 12 of the global population living with chronic hepatitis B or C and over a million deaths annually. At the end of 2006, an estimated 271,000 people living in Australia had been exposed to the hepatitis C virus. Of these, an estimated 202,400 people were living with chronic hepatitis C infection. In addition, up to 160,000 people in Australia are living with chronic hepatitis B. This translates to 1 in 55 people living with hepatitis B or C in Australia. Increased awareness regarding viral hepatitis is necessary to help reduce the incidence, prevalence and disease burden.

Forum Aims

To use the opportunity to:

• promote awareness of viral hepatitis through providing an overview of the epidemiology in Australia;
• flag the current government policy directions by engaging the areas within the Department whose business is affected by viral hepatitis eg: Drug Strategy Branch, OATSIH, Office of Health Protection;
• examine the issues relating to drug use in Australia and the prevalence of hepatitis, particularly in the Aboriginal & Torres Strait Islander population and people from culturally and linguistically diverse backgrounds;
• present the evidence relating to effective prevention interventions and current treatments;
• identify the future challenges in relation to hepatitis policy and programs, through an interactive panel of experts.

Top of Page

The Forum

Ms Jenny Bourne, Assistant Secretary, Targeted Prevention Programs Branch, on behalf of Mr David Learmonth, provided a welcome and a background to current public policy around viral hepatitis in Australia. She highlighted the various resource materials available to attendees, in particular the 2nd Edition of the National Hepatitis C Resource Manual that was hot off the press.

Key specialists in the field of viral hepatitis presented their latest findings.

Presentation 1. Building the Evidence

Dr Lisa Maher from the National Centre for HIV Epidemiology and Clinical Research (NCHECR), presented an epidemiological overview of viral hepatitis in Australia, and highlighted research findings from local preventative interventions.

Presentation 2. Treatment in Australia (PDF 219 KB)

Professor Bob Batey, Professor of Medicine and Gastroenterology, presented a clinical overview of viral hepatitis treatment in Australia, highlighting what will make a difference in supporting people to access treatment. This is a particularly important issue in Aboriginal & Torres Strait Islander communities, and in the prison population.

Presentation 3. Putting the chronic into hepatitis B (PDF 60 KB)

Mr Jack Wallace from the Australian Research Centre in Sex, Health and Society (ARCSHS), presented his research findings into the needs of communities affected by hepatitis, in particular hepatitis B. He drew some conclusions as to the workforce implications from the research study. National Hepatitis B Needs Assessment 2007 is availabe on Latrobe University website.

Presentation 4. The value of peer education and support (PDF 107 KB)

Ms Annie Madden, Executive Officer of The Australian Injecting and Illicit Drug Users League (AIVL), highlighted the important advocacy responsibilities inherent in the role of peek bodies like AIVL. She showed how peer education and support plays a vital role in communities affected by hepatitis.

Panel Discussion

Some key issues raised by attendees were addressed by panel members.

Q. How many people with chronic hepatitis require liver transplants?

A. 50-60 a year in Australia.

Q. Why is rate of hepatitis high among women?

A. Hepatitis prevalence is high in the prison population. Recent studies indicate that two thirds of all female inmates are, or have been infected with hepatitis. There is often a high number of women in prison for drug-related crime. As well, among injecting drug users it is common for the female in a relationship to inject after her partner, putting women at increased risk of infection.

Q. How can governments better manage the hepatitis epidemic?

A. The good news is we already have in place a network of nationally funded organisations working collaboratively to better meet the needs of people affected by viral hepatitis. This partnership approach facilitates better information sharing, less duplication of effort and a sharing of experience and educational resources. The government has provided ongoing funding for service provision to support key target groups in the community.

Q. Why do the majority of people with hepatitis decide not to undergo treatment?

A. There are many barriers to people accessing treatment, including stigma, lack of information, misinformation, lack of support, poor physical and mental health, continued illicit drug use. Some important enablers include the establishment of pharmacotherapy programs, Needle and Syringe Programs (NSPs), subsidised testing and treatment, and the removal of barriers to treatment, eg the need for a liver biopsy. We need to find ways to better support certain groups, eg. people in custodial settings, Aboriginal and Torres Strait Islander communities, where disease incidence and prevalence is higher than in the general population.

Q. How to reduce the spread of infection?

A. Very early intervention is required, particularly with young, new injecting drug users. There is a small window of opportunity to prevent transmission of infection. Our current intervention efforts are too late. Education about risk factors must begin in schools. Preventive education and treatment and testing intervention in custodial settings is critical.

Q. Why is liver biopsy still a requirement for hepatitis B treatment?

A. Hepatitis B is a very complex disease and consequently the treatment has to be very carefully monitored. The treatment is potentially lethal. A liver biopsy is used to assist in monitoring liver damage.

General Comment: Building the evidence is one part of the equation in addressing the viral hepatitis epidemic worldwide, goodwill and an ongoing commitment by governments to better supporting those communities at risk of transmission or affected by hepatitis is also required.