Harm Reduction Victoria

HRVic Position Papers 2015-2016

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Position on new developments in Hepatitis C Treatment

Harm Reduction Victoria (HRV) applauded the Australian federal government’s announcement late in 2015 regarding availability of the new highly effective direct acting antiviral (DAA) regimens for treatment of the hepatitis C virus (HCV), and particularly that the medications were covered by the Pharmaceutical Benefits Scheme (PBS) as of 1 March 2016 (Australian Government Department of Health, 2016).

Because of the current high price of the new treatments, subsidisation by the PBS means that these life saving medications are now accessible to thousands of Victorians aged over 18 who are living with a chronic HCV infection (Australian Government Department of Health, 2016). We know that people who inject drugs (PWID) are at highest risk of HCV in the Australian context and that 90 per cent of new infections occur among the injecting community (Hellard, Sacks-Davis, Gold, 2009).

Estimates suggest that approximately 25,000 people inject drugs in Victoria, and about 50% have chronic HCV infection (Hellard, 2015; Hellard, Jenkinson, Higgs et al., 2012). This represents a sizeable number of people who according to the PBS definition are now eligible for HCV treatment. There is support for the integration of peer workers within clinical settings to improve PWID access and uptake of HCV treatment (Crawford & Bath, 2013; Keats, Hunter et al., 2013; Norman et al. 2008; Treloar et al. 2015).

As the Victorian drug user organisation, HRV is ideally placed to play a meaningful role in reducing the HCV related burden of disease among people in our community. Our community comprises the priority populations targeted by the Fourth National Hepatitis C Strategy 2014-2017 and its guiding principles (Australian Government Department of Health, 2016). Forged through experience, we have a unique perspective that can be harnessed as part of a broader Victorian strategy that contributes to eliminating HCV among our constituents.

In the following document, we outline HRV’s position on the new developments in HCV treatment. First, we describe our priority areas of action. Second, we propose a range of peer driven, cost-effective solutions to support their achievement. Solutions may be relevant across several priority areas and, equally, priorities may relate to a number of solutions.

While there is need for HRV to play a leadership role in the new HCV treatment landscape, many of our proposals challenge our current resourcing and capacity and are contingent on additional sources of funding.

 

Jenny Kelsall, Executive Officer

Harm Reduction Victoria

 

 

References

Australian Government Department of Health (2016). Hepatitis C Medicines Fact Sheet for Consumers. Canberra: Australian Government Department of Health.

Australian Government Department of Health (2016). Fourth National Hepatitis C Strategy, 2014-2017. Canberra: Australian Government Department of Health.

Crawford, S. & Bath, N. (2013). Peer support models for people with a history of injecting drug use undertaking assessment and treatment for hepatitis c virus infection. Clinical Infectious Diseases 57(S2), S75-79.

Hellard, M. (2015). Updated policy brief: People who inject drugs can be successfully treated for HCV, and treatment has the potential to reduce the community prevalence of HCV. Policy Brief No. 3. Melbourne: Centre for Research Excellence into Injecting Drug Use.

Hellard, M., Jenkinson, R., Higgs P., Stoove, M., Sacks-Davis, R., Gold, J., Hickman, M., Vickerman, P. and Martin, N. K. (2012). Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia. MJA 196(10), 638-41.

Hellard, M., Sacks-Davis, R. & Gold, J. (2009). Hepatitis C treatment for injection drug users: A review of the available evidence. Clinical Infectious Diseases 49, 561-73.

Keats, J., Micallef, M., Grebely, J., Hazelwood, S., Everingham, H., Shrestha, N., Jones, T., Bath, N., Treloar, C., Dore, G.J., Dunlop, A. (2015). Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia. International Journal of Drug Policy 26, 999-1006.

Norman, J., Walsh, N.M., Mugavin, J., Stoove, M., Kelsall, J., Austin, K. & Lintzeris, N. (2008). The acceptability and feasibility of peer support worker role in community based hepatitis C treatment for injecting drug users. Harm Reduction Journal 5(8).

Treloar, C., Rance, J., Bath, N., Everingham, H., Micallef, M., Day, Carolyn, D., Hazelwood, S., Grebely, J. & Dore, G.J. (2015). Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia. International Journal of Drug Policy 26, 992-998.

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