Existing hepatitis C surveillance systems need to be enhanced to provide accurate data to inform the planning and delivery of prevention and disease management options.
Hepatitis C surveillance involves the systematic and continuous collection, analysis, interpretation and dissemination of hepatitis C prevalence, incidence and behavioural data. Surveillance data are used to identify people at risk of infection, the long-term outcomes of infection and provide data for governments to target and evaluate hepatitis C prevention and treatment activities.
Acute, or newly acquired, and chronic hepatitis C infection cases are routinely notified through public health surveillance systems with limited demographic information. The data are forwarded to the Australian Government’s National Notifiable Diseases Surveillance System for collating and national reporting.
Notifications of newly acquired hepatitis C underestimate the true incidence of the infection, while notifications of unspecified or chronic cases underestimate the burden of disease related to hepatitis C. For these reasons, the response to hepatitis C has relied on modelling of the incidence and prevalence of the disease.
Australia has one of the best surveillance systems in the world for monitoring the prevalence of HIV and hepatitis C infection among people who inject drugs.62, 63 Since 1995, the Australian NSP Survey has provided annual estimations of point prevalence to monitor changes over time in patterns of infection and risk behaviours among NSP clients. With sample sizes ranging between 1072 (in 1995) and 2694 (in 2000), results can be generalised to all Australian public sector NSP clients—the samples are considered to be as representative as can be practically obtained.64 With increased resources and new methods currently available Australia could potentially use this data to estimate HIV and hepatitis C virus incidence in people who inject drugs.65 However, further work is needed to document and understand the heterogeneity of people who inject drugs including those who exclusively attend pharmacy NSP outlets or rely on others to provide equipment and hence would not be part of the existing NSP surveillance systems.66, 67
Priority action in surveillance
- Develop and implement a National Viral Hepatitis Surveillance Strategy under the supervision of the Communicable Diseases Network of Australia which facilitates the collection of demographic data, including country of birth, Indigenous Australian status and sentinel surveillance for priority populations.
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62 MacDonald et al. 1997 and 2000, Australian Needle and Syringe Program (NSP) Survey, University of New South Wales, Sydney.
63 National Centre in HIV Epidemiology and Clinical Research 2008, ‘Australian NSP Survey National Data Report 2003–2007’, National Centre in HIV Epidemiology and Clinical Research, University of NSW.
64 Topp, L et.al. ‘Representativeness of Injecting Drug Users Who Participate in HIV Surveillance: Results From Australia’s Needle and Syringe Program Survey’, Journal of Acquired Immune Deficiency Syndromes 2008, 47, 5, pp. 632–638 <http://journals.lww.com/jaids/Fulltext/2008/04150/Representativeness_of_Injecting_Drug_Users_Who.15.aspx>.
65 Kwon JA, Iversen, J, Maher L, Law MG & Wilson DP 2009, ‘The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis’, Journal of Acquired Immune Deficiency Syndrome, August 1; 51(4).
66 Bryant J & Treloar C 2006, Risk practices and other characteristics of injecting drug users who obtain injecting equipment from pharmacies and personal networks. International Journal of Drug Policy 17: pp. 418–24.
67 Bryant J, Topp L, Hopwood M, Iversen J, Treloar C & Maher L, ‘Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south east Sydney’, Drug and Alcohol Review. In press. Accepted September 2009.