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Australia will miss HBV elimination targets despite improved care

Results from an estimation model revealed that Australia will marginally miss both its local targets and the WHO’s global targets for eliminating chronic hepatitis B.

However, researchers described comprehensive modelling approaches that account for diversity within the country’s population as a tool to measure progress, impact interventions and quantify further improvements needed to meet elimination goals.

“Through ongoing migration from endemic populations, the number of Australians living with [chronic HBV (CHB)] has continued to increase, with CHB now more prevalent in Australia than HIV and chronic hepatitis C combined,” Karen L. McCulloch, PhD, NCS, from the Doherty Institute in Melbourne, Australia, and colleagues wrote. “Universal infant hepatitis B vaccination programs in Australia and overseas are reducing transmission, especially to infants, and while this is not yet significantly impacting on the prevalence of CHB among adult migrants, the prevalence of CHB in this group is expected to fall significantly in coming years.”

McCulloch and colleagues reported that the prevalence of CHB in Australia doubled from 0.6% in 1970 to 0.9% in 2017, with “substantial variation across age groups.” Diagnosis improved, however, from 63% in 2011 of all those living with CHB to 68% in 2017.

Based on the current average annual increase of 0.78% diagnosed cases since 2011, Australia will not meet the WHO target of 80% by 2033. To reach the local target of 80% by 2022, the proportion would need to increase by 1.72% every year.

While uptake of HBV treatment also increased by approximately 0.93% per year from 2011 to 2017, Australia will still miss its local target of 20% of people with CHB on treatment by 2022 without an annual increase of 2.3%.

“If treatment uptake continues to increase at the current rate, there will only be a 5.7% reduction in deaths in 2030 compared to 2015,” McCulloch and colleagues wrote. “Furthermore, under the intermediate and optimistic treatment scenarios, the WHO 2030 target of a 65% reduction in hepatitis B related mortality is not met.”

The researches noted that policy changes to allow general practitioners to treat patients with CHB improved uptake, more than 85% of CHB treatment in 2017 was still provided by specialists and access was lower outside of major cities.

“This emphasizes the importance of having national strategy targets to strive for on the way to the global 2030 targets,” they concluded. “It indicates the importance of ensuring people affected are engaged in care and have access to relevant treatment earlier in order to achieve a higher reduction in attributable mortality by 2030.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.