High-coverage treatment scale-up is required if Australia is to eliminate HCV as a public health threat

PLoS ONE 13(6): e0198336.
Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas
Samuel W. Hainsworth, Paul M. Dietze,David P. Wilson, Brett Sutton, Margaret E. Hellard, Nick Scott

Published: June 18, 2018

https://doi.org/10.1371/journal.pone.0198336 

High-coverage treatment scale-up is required if Australia is to eliminate HCV as a public health threat, and this scale-up is necessary now if we are to achieve the WHO elimination targets by 2030. While this is only a preliminary analysis of the HCV burden, the findings provide important information for service prioritisation and planning, highlighting that the per capita burden of HCV is greatest in socioeconomically disadvantaged areas and the unmet demand for HCV services is greatest in geographic areas outside major cities. Our results suggest that strategies for HCV prevention and treatment in Australia would benefit from considering these factors. Any future research which has access to testing and treatment data could provide greater insight for the development of needs-based service planning. Despite this, the data used in our analysis are routinely available demographic and health service data, meaning that our analysis can serve as a useful framework for the ongoing monitoring of Australia’s efforts to eliminate HCV. Additionally, a similar framework for service planning could be employed in other countries wanting to scale up HCV testing and treatment in an effort to achieve HCV elimination.

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Abstract
Background
Poor access to health services is a significant barrier to achieving the World Health Organization’s hepatitis C virus (HCV) elimination targets. We demonstrate how geospatial analysis can be performed with commonly available data to identify areas with the greatest unmet demand for HCV services.

Methods
We performed an Australia-wide cross-sectional analysis of 2015 HCV notification rates using local government areas (LGAs) as our unit of analysis. A zero-inflated negative binomial regression was used to determine associations between notification rates and socioeconomic/demographic factors, health service and geographic remoteness area (RA) classification variables. Additionally, component scores were extracted from a principal component analysis (PCA) of the healthcare service variables to provide rankings of relative service coverage and unmet demand across Australia.

Results
Among LGAs with non-zero notifications, higher rates were associated with areas that had increased socioeconomic disadvantage, more needle and syringe services (incidence rate ratio [IRR] 1.022; 95%CI 1.001, 1.044) and more alcohol and other drug services (IRR 1.019; 1.005, 1.034). The distribution of PCA component scores indicated that per-capita healthcare service coverage was lower in areas outside of major Australian cities. Areas outside of major cities also contained 94% of LGAs in the lowest two socioeconomic quintiles, as well as 35% of HCV notifications despite only representing 29% of the population.

Conclusions

As countries aim for HCV elimination, routinely collected data can be used to identify geographical areas for priority service delivery. In Australia, the unmet demand for HCV treatment services is greatest in socioeconomically disadvantaged and non-metropolitan areas.

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