1.1. The guiding principlesThe eight key principles that guide hepatitis C testing in Australia are:
- confidential, voluntary testing with informed consent and pre-test and post-test discussion is fundamental to Australia’s response to hepatitis C;
- testing is of the highest possible standard;
- testing is of benefit to the person being tested;
- testing is accessible to all those at risk of HCV infection;
- testing is critical to understanding the epidemiology of HCV infection in the community;
- testing can be critical to interruption of transmission and can support harm minimisation; and
- testing to monitor people with hepatitis C before, during and after treatment is an integral part of their care.
1.2. Specific issues concerned with the application of the principlesThere are consequences that follow from the development and implementation of a national testing policy. These are set out briefly below, further discussion of the guiding principles is found in Appendix 3.
Testing policy and consequent practices must comply with all relevant Australian Government and State and Territory anti-discrimination legislation, public health, and other relevant laws.
The testing policy is supported by congruent, local jurisdictional policies. These local policies foster the implementation of the national policy. For example, individual, community and professional education and support are fundamental to high quality and ethical testing for hepatitis C; this is provided at a State and Territory service level. Free and anonymous testing for hepatitis C, that does not require identification or a Medicare number, continues to be offered by some State and Territory funded health services.
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Anonymous, de-linked testing occurs under circumstances that are scientifically justified and generate a positive public outcome. Such testing proposals should be assessed and agreed to by ethics committees constituted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research.
Testing does not diminish the need for standard precautions in handling blood, body fluids, tissues and organs in all health care settings. The Australian Government Department of Health and Ageing’s Infection Control Guidelines for the prevention of transmission of infectious diseases in the health care setting (2004)2 sets out the key elements of standard precautions.
Mandatory or compulsory testing for hepatitis C is appropriate in certain rare circumstances (see Appendix 3). All testing whether it is voluntary, compulsory or mandatory, should all be accompanied by appropriate pre-test and post-test discussion.
2Department of Health and Ageing. Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting. Commonwealth of Australia, Department of Health and Ageing. Canberra 2004.