Hepatitis C in Primary Care and Case Finding

Closing the Gap on Elimination

Australia committed to eliminating hepatitis C as a public health threat by 2030, aligning with World Health Organization goals of slashing incidence by 90% and mortality by 65% from 2015 levels. The cornerstone has been unrestricted PBS listing of direct-acting antivirals since March 2016, enabling primary care providers to prescribe curative treatments with high success rates and minimal side effects.

Progress has been substantial: cumulative first-time treatments reached over 111,000 by end-2024, with total initiations including retreatments hitting 129,233. Prevalence has fallen by more than half, new infections have declined markedly—especially among women—and liver-related complications, including transplants, continue to drop. In 2024, about 5,238 people started treatment for the first time, down from peak years immediately after PBS access.

This slowdown in treatment uptake threatens the final stretch. Modelling indicates that even under a pessimistic scenario of around 4,000 annual treatments from 2025 onward, Australia could meet the 80% treatment coverage target by 2030, but the mortality reduction goal would fall short. Sustained or increased efforts are essential to locate undiagnosed or disengaged cases, particularly among priority groups like people who inject drugs, Aboriginal and Torres Strait Islander communities, and those in prisons.

Case finding in primary care has emerged as a pivotal strategy. Initiatives like ASHM's Beyond the C program target general practices to identify the estimated tens of thousands still unaware or unlinked to care. Active follow-up of notifications has proven cost-effective, boosting RNA confirmation and treatment starts in pilots. Yet non-obvious tensions persist: while prison treatments accounted for 41% of 2024 initiations, broader community access shows regional variations of up to 60% below national averages. Stigma remains entrenched—about one-third of Australians report negative attitudes toward people with hepatitis C—compounding disengagement and reinfection risks.

The clock is ticking toward 2030, with the Sixth National Hepatitis C Strategy emphasizing equitable testing expansion, point-of-care innovations, and reflex testing to streamline diagnosis and linkage.