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Background: Highly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment. Aims: To identify gaps in the cascade of care for hepatitis C and generate estimates of the number living with untreated infection according to population group, using a representative longitudinal study population. Methods: We linked hepatitis C notification data from Victoria to national pathology, prescribing and death registry data. We assessed receipt of key clinical services in a large cohort who tested positive for hepatitis C from 1 January 2000 to 31 December 2016, with follow‐up to 30 June 2018. We estimated the number still living with hepatitis C, adjusting for spontaneous clearance and mortality. Results: The cohort comprised 45 391 people positive for hepatitis C. Of these, 13 346 (29%) received treatment and an estimated 28% (95% confidence interval (CI): 26–30%) were still living with chronic infection at 30 June 2018, with the remainder still living following spontaneous clearance (30%, 95% CI: 29–32%) or having died (12%, 95% CI: 12–12%). Half (50%) of those still living with hepatitis C were born from 1965 to 1980, and 74% first tested positive before 2011. Conclusions: Despite an enabling policy environment and subsidised therapy, many people in this cohort were not treated. Increased measures may be needed to engage people in care, including those who acquired hepatitis C more than 10 years ago. [ABSTRACT FROM AUTHOR]

This article discusses the importance of eliminating perinatal transmission of hepatitis B virus (HBV) and the strategies that can be implemented to achieve this goal. Chronic HBV infection is a major cause of liver cirrhosis and liver cancer, resulting in a significant number of deaths worldwide. The primary mode of HBV transmission is from mother to child during childbirth or early childhood. Vaccination is a highly effective method of preventing HBV infection, with the hepatitis B vaccine being over 90% effective. However, coverage with timely vaccination has been suboptimal in many regions. The article emphasizes the need for urgent action to introduce timely vaccination, especially in high-prevalence settings. Additionally, screening pregnant women for HBV infection and providing antiviral treatment for eligible individuals are crucial in preventing perinatal infections and reducing the progression of liver disease. Integration of HBV elimination efforts with existing HIV and syphilis services can be cost-effective and feasible. The World Health Organization (WHO) has developed guidelines and a framework to guide the implementation of integrated interventions to scale up the elimination of perinatal HBV transmission. The article concludes by calling for joint and coordinated action to achieve the goal of eliminating perinatal HBV transmission by 2030. [Extracted from the article]

COVID-19 mortality and morbidity data should include information on vaccination status, and both eligibility and receipt of COVID-19 oral antivirals. Access to oral COVID-19 antivirals in the community: are eligibility criteria and systems ensuring equity? Keywords: COVID-19; Public health EN COVID-19 Public health 438 441 4 06/06/23 20230601 NES 230601 With substantial SARS-CoV-2 transmission in the community, early oral antiviral access has become a pillar of our response Oral antiviral therapies for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) are recommended in Australian guidelines to reduce the risk of serious illness, hospitalisation and mortality in people who do not require oxygen and have risk factors for progression to severe disease.[1] Oral treatments should be started within five days after onset of symptoms, or as soon as practical after diagnosis in an asymptomatic individual.[1] With substantial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in the community and great health system pressures and excess mortality nationwide due to COVID-19 (most of which has been experienced in 2022), early oral antiviral access has become a pillar of our response. Integrating general practice into the Australian COVID-19 response: a description of the General Practitioner Respiratory Clinic Program in Australia. [Extracted from the article]

Background and Aim: This study aimed to assess utilization of health‐care services in people with decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) and a "late diagnosis" of hepatitis B or hepatitis C. Methods: Hepatitis B and C cases during 1997–2016 in Victoria, Australia, were linked with hospitalizations, deaths, liver cancer diagnoses, and medical services. A late diagnosis was defined as hepatitis B or hepatitis C notification occurring after, at the same time, or within 2 years preceding an HCC/DC diagnosis. Services provided during the 10‐year period before HCC/DC diagnosis were assessed, including general practitioner (GP) or specialist visits, emergency department presentations, hospital admissions, and blood tests. Results: Of the 25 766 notified cases of hepatitis B, 751 (2.9%) were diagnosed with HCC/DC, and hepatitis B was diagnosed late in 385 (51.3%). Of 44 317 cases of hepatitis C, 2576 (5.8%) were diagnosed with HCC/DC, and hepatitis C was diagnosed late in 857 (33.3%). Although late diagnosis dropped over time, missed opportunities for timely diagnosis were observed. Most people diagnosed late had visited a GP (97.4% for hepatitis B, 98.9% for hepatitis C) or had a blood test (90.9% for hepatitis B, 88.6% for hepatitis C) during the 10 years before HCC/DC diagnosis. The median number of GP visits was 24 and 32, and blood tests 7 and 8, for hepatitis B and C, respectively. Conclusions: Late diagnosis of viral hepatitis remains a concern, with the majority having frequent health‐care service provision in the preceding period, indicating missed opportunities for diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To assess associations between SARS‐CoV‐2 infection and the incidence of hospitalisation with selected respiratory and non‐respiratory conditions in a largely SARS‐CoV‐2 vaccine‐naïve population. Design, setting, participants: Self‐control case series; analysis of population‐wide surveillance and administrative data for all laboratory‐confirmed COVID‐19 cases notified to the Victorian Department of Health (onset, 23 January 2020 – 31 May 2021; ie, prior to widespread vaccination rollout) and linked hospital admissions data (admission dates to 30 September 2021). Main outcome measures: Hospitalisation of people with acute COVID‐19; incidence rate ratios (IRRs) comparing incidence of hospitalisations with defined conditions (including cardiac, cerebrovascular, venous thrombo‐embolic, coagulative, and renal disorders) from three days before to within 89 days of onset of COVID‐19 with incidence during baseline period (60–365 days prior to COVID‐19 onset). Results: A total of 20 594 COVID‐19 cases were notified; 2992 people (14.5%) were hospitalised with COVID‐19. The incidence of hospitalisation within 89 days of onset of COVID‐19 was higher than during the baseline period for several conditions, including myocarditis and pericarditis (IRR, 14.8; 95% CI, 3.2–68.3), thrombocytopenia (IRR, 7.4; 95% CI, 4.4–12.5), pulmonary embolism (IRR, 6.4; 95% CI, 3.6–11.4), acute myocardial infarction (IRR, 3.9; 95% CI, 2.6–5.8), and cerebral infarction (IRR, 2.3; 95% CI, 1.4–3.9). Conclusion: SARS‐CoV‐2 infection is associated with higher incidence of hospitalisation with several respiratory and non‐respiratory conditions. Our findings reinforce the value of COVID‐19 mitigation measures such as vaccination, and awareness of these associations should assist the clinical management of people with histories of SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has affected different parts of Australia in distinct ways across 2020 and 2021. In 2020, Melbourne was the epicentre of COVID‐19. As one of the key tertiary centres caring for the patients affected by the outbreaks, the Royal Melbourne Hospital (RMH) managed the majority of the Victorian inpatient caseload. Aims: To review the demographics, management and outcomes of patients with COVID‐19 cared for by the RMH services in 2020. Methods: A single health service retrospective cohort analysis of demographics, interventions and outcomes was conducted to characterise the RMH experience in 2020. Results: From January to December 2020, 433 patients required admission more than 24 h. The demographics of affected patients and outcomes changed over the course of the study. Overall, 47% (203/433) required oxygen, most frequently (36%; 154/433) with low‐flow devices (nasal prongs or hudson mask), and 11% (47/433) of patients required admission to intensive care. We recorded a 30‐day mortality of 24% (104/433) mortality overall, rising to over 50% in patients aged over 80 years. Conclusions: The experience of this health service in 2020 demonstrated changing demographics over time, with associated differences in outcomes; notably marked mortality in older populations, frequent complications and limited inter‐site transfer possible with mobilised resources. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC). Main recommendations: This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis. Change in management as a result of this guideline: These recommendations aim to raise awareness of the current management of hepatitis B in Australia. Critically, the timely identification of individuals living with hepatitis B, and where appropriate, commencement of antiviral therapy, can prevent the development of cirrhosis, HCC and mother‐to‐child transmission as well as hepatitis B reactivation in immunocompromised individuals. Recognising patient and viral factors that predispose to the development of cirrhosis and HCC will enable clinicians to risk‐stratify and appropriately implement surveillance strategies to prevent these complications of hepatitis B. [ABSTRACT FROM AUTHOR]

Objectives: To assess the capacity of the COVID Positive Pathway, a collaborative model of care involving the Victorian public health unit, hospital services, primary care, community organisations, and the North Western Melbourne Primary Health Network, to support people with coronavirus disease 2019 (COVID‐19) isolating at home. Design, setting, participants: Cohort study of adults in northwest Melbourne with COVID‐19, 3 August ‒ 31 December 2020. Main outcome measures: Demographic and clinical characteristics, and social and welfare needs of people cared for in the Pathway, by care tier level. Results: Of 1392 people referred to the Pathway by the public health unit, 858 were eligible for enrolment, and 711 consented to participation; 647 (91%) remained in the Pathway until they had recovered and isolation was no longer required. A total of 575 participants (81%) received care in primary care, mostly from their usual general practitioners; 155 people (22%) received care from hospital outreach services, and 64 (9%) needed high tier care (hospitalisation). Assistance with food and other basic supplies was required by 239 people in the Pathway (34%). Conclusions: The COVID Positive Pathway is a feasible multidisciplinary, tiered model of care for people with COVID‐19. About 80% of participants could be adequately supported by primary care and community organisations, allowing hospital services to be reserved for people with more severe illness or with risk factors for disease progression. The principles of this model could be applied to other health conditions if regulatory and funding barriers to information‐sharing and care delivery by health care providers can be overcome. [ABSTRACT FROM AUTHOR]

Background & Aims: We aim to capture the economic impact of a potential cure for chronic hepatitis B infection (CHB) in three countries (USA, China and Australia) with different health systems and epidemics to estimate the threshold drug prices below which a CHB cure would be cost‐saving and/or highly cost‐effective. Methods: We simulated patients' hepatitis B progression, under three scenarios: current long‐term suppressive antiviral therapy, functional cure defined as sustained undetectable HBsAg and HBV DNA, and partial cure defined as sustained undetectable HBV DNA only after a finite, 48‐week treatment. Results: Compared with current long‐term antiviral therapy, a 30% effective functional cure among patients with and without cirrhosis in the USA, China and Australia would yield 17.50, 17.32 and 20.42 QALYs per patient, and 20.61, 20.42 and 20.62 QALYs per patient respectively. In financial terms, for CHB patients with and without cirrhosis, this would be cost‐saving at a one‐time treatment cost under US$11 944 and US$6694, respectively, in the USA, US$1744 and US$1001 in China, and US$12 063 and US$10 983 in Australia. Conclusion: We show that in purely economic terms, a CHB cure will be highly cost‐effective even if effective in only 30% of treated patients. The threshold price for cure is largely determined by the current antiviral drug costs, since it will replace a daily antiviral pill that is inexpensive and effective, although not curative. The likely need for combination therapies to achieve cure will also present cost challenges. While cost‐effectiveness is important, it cannot be the only consideration, as cure will provide many benefits in addition to reduced liver disease and HCC, including eliminating the need for a long‐term daily pill and reducing stigma often associated with chronic viral infection. [ABSTRACT FROM AUTHOR]

The latter parameter has substantial influence on the question of whether a universal testing approach is likely to be cost-effective.[8] Testing alone cannot achieve the desired individual or public health outcomes; what happens after a positive test result determines the benefits realised. Keywords: Hepatitis B; Public policy; Mass screening EN Hepatitis B Public policy Mass screening 165 166 2 03/08/23 20230301 NES 230301 Comprehensive testing, monitoring, and treatment in primary care could save hundreds of Australian lives each year Tens of thousands of Australians have undiagnosed chronic hepatitis B, most since infancy.[1] Chronic hepatitis B is an important cause of cirrhosis, liver failure, and hepatocellular carcinoma. [Extracted from the article]

Background and Aim Methods Results Conclusions Pregnancy is a key setting for engagement in chronic hepatitis B (CHB) care, due to the implications for transmission to the infant and antenatal diagnosis representing an opportunity for ongoing follow‐up. This study aimed to identify the coverage and predictors of clinical care for women with CHB during and after pregnancy in a population‐level cohort.Notified CHB cases in Victoria, Australia, were linked with hospitalizations, medical services, and prescribing data, covering the period 1991–2018. Women with an admission for a live birth were identified and services provided during pregnancy were assessed, including general practitioner (GP) or specialist visits, viral load and serology testing, and antiviral treatment. Viral load and serology testing coverage ware also assessed for the 2‐year period following pregnancy. Demographic and clinical predictors of viral load testing during pregnancy were assessed.A total of 11 015 birth events occurred for 6090 women with CHB. During pregnancy most had a GP consultation (91.6%); however, only 39.5% had viral load testing and 41.4% had a gastroenterology or infectious diseases specialist consultation. Viral load testing and serology testing in the 2 years after pregnancy occurred in approximately half (47.9% and 52.2%, respectively) with increases over time. Viral load testing was more likely in those born overseas, those with more than one previous birth, and those living in Melbourne.Despite improvements over time, key gaps were identified in the provision of CHB clinical care during and after pregnancy, with implications for ongoing transmission and adverse outcomes. [ABSTRACT FROM AUTHOR]