Public health unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia

Abstract

Objective: To determine hepatitis C virus (HCV) treatment rates among those newly diagnosed with the virus in the South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Study type: Cross-sectional study of patients newly diagnosed with HCV in SWSLHD, based on local Public Health Unit notification data from the second half of 2017. Methods: A total of 200 consecutive notifications were enrolled in the study. Either the ordering clinician was interviewed, and/or data linkage with local hospital records performed, to determine rates of antiviral treatment in this cohort. Outcomes measured included the proportion of patients: started on antiviral treatment; referred to specialists for consideration of treatment; HCV ribonucleic acid (RNA) negative; and lost to follow-up. Descriptive analysis of factors contributing to those lost to follow-up was performed where available. Results: The follow-up outcome of 93% of patients was traced. General Practitioners (GPs) diagnosed a similar number (102) of new HCV cases to those diagnosed by specialists (94). After detecting a patient as HCV antibody positive and confirming active infection, GPs preferred to refer patients to specialists (53%), rather than further evaluate and treat patients themselves (5%). The remainder of cases from the GP-detected group were lost to follow-up (26%), or HCV RNA negative (16%). Among the speciliastdetected patients, 41% were treated, 18% were lost to follow-up, 20% were RNA negative and the remainder were not treated for reasons including a concurrent diagnosis of hepatocellular carcinoma, or death. The most common reason patients were not started on antiviral treatment was loss to follow-up. Conclusion: We found that less than half (47%) of people in South Western Sydney newly diagnosed with HCV, in whom treatment was indicated, received antiviral medication in the 12 months following diagnosis.This figure excludes the 25% cases referred from general practice to specialists, in whom the treatment status is unknown. Approximately one in five newly diagnosed patients (22%) were lost to follow-up and 18% were RNA negative, indicating they had no active HCV infection.