Hepatitis C infection remains a major public health problem in Australia. There were 10,537 hepatitis C notifications in Australia in 2017.2 Influenced by multiple factors, infection persists in between 55–85% of those with the infection. In 2017, an estimated 182,144 Australians were living with chronic hepatitis C. Cirrhosis develops within 20 years in 5–10% of this group (usually associated with other comorbidities such as co-infection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV), obesity, insulin resistance, alcohol intake over 40 g each day) and in a further 10–15% after 40 years.6 Hepatocellular carcinoma will develop in 3–5% of people per annum who develop cirrhosis.7
Preventive interventions have proven effective in decreasing HCV transmission and therapeutic interventions are effective in improving quality of life and clinical outcomes for people with HCV infection. New treatments subsidised on the Pharmaceutical Benefits Scheme (PBS) since March 2016 have greatly improved HCV sustained viral responses (SVR) and treatment numbers have risen dramatically from pre-DAA agent levels. The newest agents, which are pangenotypic have been shown to be safe and highly effective and, in 2019, almost 50% of prescriptions for these new drugs were written by doctors in primary-care settings.8
This edition of the Testing Policy seeks to define the current best practice for testing for exposure (or re-exposure) to the virus and for defining the current infective status of the person before, during and after treatment.
HCV testing can provide people with information regarding exposure to the virus. Appropriate testing indicates whether the person being tested has cleared the virus spontaneously or with antiviral therapy or has an ongoing (chronic) infection.
The benefits of reliable, timely testing are numerous, both for the person being tested and for public health. Detection of HCV infection followed by appropriate education can effectively reduce onward transmission by empowering people living with hepatitis C infection to modify their risk behaviour, modify their disease progression through earlier referral for advice and treatment, and protect the blood, tissue and organ donation supply. Despite the public health and individual benefits of testing, a significant but undocumented number of people with hepatitis C infection in Australia remain undiagnosed.
It is therefore crucial that those people responsible for implementing this Policy (particularly those obtaining informed consent and providing test results) have the necessary skills and knowledge to fully communicate the significance of each of the available tests to the person being tested. This Policy document assumes that all staff involved in the testing process are appropriately trained.