Challenges and opportunities for enhanced services
Over 300 000 Australians have been exposed to hepatitis C virus (HCV), of whom an estimated 226 700 are living with chronic infection, including 16 000 Indigenous Australians.1,2 Transmission of HCV occurs via blood-to-blood contact, most notably via injecting drug use.3 About 10 000 new infections are estimated to occur annually, and only 25% of infected individuals clear the virus during acute infection. Accordingly, the population living with chronic infection is steadily increasing.3,4 Over the next 20–40 years, about 20% of individuals with chronic hepatitis C are estimated to progress to cirrhosis,5 and thereafter 3% will die each year from liver failure or hepatocellular carcinoma.6 Chronic hepatitis C is already the leading indication for liver transplantation in Australia.4
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- 1. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2012. Sydney: University of New South Wales, 2012.
- 2. Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis C Sub-Committee. Hepatitis C Virus Projections Working Group: estimates and projections of the hepatitis C virus epidemic in Australia 2006. Sydney: National Centre in HIV Epidemiology and Clinical Research, 2006.
- 3. Department of Health and Ageing. Third national hepatitis C strategy 2010–2013. Canberra: Commonwealth of Australia, 2010.
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- 8. Butler T, Papanastasiou C. National prison entrants’ bloodborne virus and risk behaviour survey report 2004 and 2007. Perth: National Drug Research Institute, 2008.
- 9. Boonwaat L, Haber PS, Levy MH, Lloyd AR. Establishment of a successful assessment and treatment service for Australian prison inmates with chronic hepatitis C. Med J Aust 2010; 192: 496-500. <MJA full text>
- 10. Bate JP, Colman AJ, Frost PJ, et al. High prevalence of late relapse and reinfection in prisoners treated for chronic hepatitis C. J Gastroenterol Hepatol 2010; 25: 1276-1280.
- 11. Batey RG, Jones T, McAllister C. Prisons and HCV: a review and a report on an experience in New South Wales Australia. Int J Prison Health 2008; 4: 156-163.
- 12. Post JJ, Arain A, Lloyd AR. Enhancing assessment and treatment of hepatitis C in the custodial setting. Clin Infect Dis 2013; 57 Suppl 2: S70-S74.
- 13. Lloyd AR, Clegg J, Lange J, et al. Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting. Clin Infect Dis 2013; 56: 1078-1084.
The workshop was funded by MSD Australia, and attendees included: John Bate, Royal Adelaide Hospital; Lyn Burke, Townsville Hospital; Jacqueline Clegg, Justice and Forensic Mental Health Network; Anton Colman, Royal Adelaide Hospital; Crystal Connelly, Fremantle Hospital; Marian Croft, Western Hospital, Victoria; Peter Frost, South Australian Prison Health Service; Katarnya Gilbert, MSD Australia; Luke Grant, Corrective Services NSW; Margaret Hellard, Burnet Institute; Stuart Loveday, Hepatitis NSW; Denise Monkley, Justice and Forensic Mental Health Network; Katherine Mellor, St Vincent’s Hospital Melbourne; Jo Sexton, Princess Alexandra Hospital; Deborah Siddall, Correctional Primary Health Service, Tasmania; Poni Tongun, Marngoneet Correctional Centre; Helen Tyrrell, Hepatitis Australia; James Ward, Baker IDI Heart and Diabetes Institute; Lorraine Yap, Kirby Institute; Amany Zekry, St George Hospital.
Lilie Herawati is entitled to MSD stocks as part of her employment.