Australia’s National Hepatitis C Testing Policy50 benchmarks the testing and diagnosis best practice standards for health professionals, people with hepatitis C, government, industry and the wider community. However, insufficient implementation of the policy has created poor diagnostic practices, including inadequate access to pre- and post-test discussions at the time of diagnosis, and subsequent insufficient referral to clinical and support services. There is also a lack of implementation of confirmatory HCV RNA (for example, by PCR ) testing for people who have had a positive hepatitis C antibody test. As a result, many people believe they have hepatitis C (based on a positive antibody test result) when in fact they have cleared the virus.51
Inadequate systems exist to ensure that people at risk of hepatitis C infection are regularly screened, although data suggest that a number of NSP service users test regularly. It is estimated that there is a pool of between 40 000 and 50 000 undiagnosed people living in the community, many of whom are members of hepatitis C priority populations.52
It is recognised that people with hepatitis C who inject drugs, people in custodial settings, Aboriginal and Torres Strait Islander peoples, people from priority CALD backgrounds, and young people often experience barriers to accessing health services. These difficulties are often compounded when seeking testing and treatment for hepatitis C. Additional resources would improve the ability of specialist and primary healthcare services to adapt to and meet the clinical needs of people with hepatitis C from priority populations. There is also a place for peer education and peer support in assisting people through the testing and diagnosis process.53
Priority actions in testing and diagnosis of hepatitis C
- Promote testing and treatment in line with guidelines.
- Ensure that people with or at risk of hepatitis C have access to high quality services at the time of diagnosis.
- Expand the National Hepatitis C Testing Policy to include hepatitis B.
- Implement targeted initiatives with priority CALD communities and healthcare providers with high caseloads of patients from priority CALD communities to promote awareness of and support measures to improve compliance with the National Hepatitis C Testing Policy.
- Develop education for people who inject drugs, those on pharmacotherapy and their healthcare providers—including all general practices and primary healthcare services—to ensure that hepatitis C testing and diagnosis process is understood and based on informed consent.
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50 Department of Health & Ageing 2005, National Hepatitis C Strategy, 2005–2008, Canberra, Commonwealth of Australia.
51 Deacon R, Newland J, Harris C, Treloar C & Maher L 2002, Hepatitis C seroconversion: Using qualitative research to enhance surveillance, National Centre for HIV Epidemiology and Clinical Research and National Centre in HIV Social Research, Sydney.
52 National Centre for HIV Epidemiology and Clinical Research 2009, HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2009. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney.
53 Aitken C & Kerger M et al. 2002, ‘Peer-delivered hepatitis C testing and counselling: A Means of improving the health of injecting drug users’, Drug and Alcohol Review, vol. 21: pp. 3–37.