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Feature Article

Eliminating hepatitis C: Part 5. Practical steps in your practice

David Baker, ANNE BALCOMB, JOSS O’LOAN, Jessica Howell
OPEN ACCESS

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© KO STUDIOS
© KO STUDIOS

Abstract

For most people with chronic hepatitis C, treatment with direct-acting antiviral (DAA) therapy is simple and easily incorporated into primary care. GPs can help in the push to eliminate hepatitis C by 2030 through strategies to eliminate hepatitis C from their own practices. This includes finding their patients with hepatitis C, assessing, treating and following up after DAA therapy.

Key Points

  • GPs can help achieve the goal of eliminating hepatitis C in Australia by 2030 through ‘microelimination’ in their own practices.
  • Since 2016, over 6000 Australian GPs have treated patients with direct-acting antiviral (DAA) therapy.
  • For most people with chronic hepatitis C, treatment with DAA therapy is simple and easily incorporated into primary care.
  • Patients can be tested for hepatitis C, assessed, treated and followed up for cure in four GP visits, with an optional fifth visit during treatment.
  • Ongoing care for patients after DAA therapy includes care of comorbidities and strategies to prevent and detect reinfection in those with ongoing risk.

Australia aims to eliminate hepatitis C by 2030. The contribution of GPs is essential to achieving this goal, and Australian GPs are leading the world in treating their patients with hepatitis C in primary care. Since the arrival of direct-acting antiviral (DAA) therapy in March 2016, over 6000 GPs have treated one or more people living with ­hepatitis C.1 GPs are also treating an increasing proportion of patients.2 At the same time, there have been steady improvements in assessment and therapy, which have made the treatment pathway even more straightforward.3 

This is the final article in the series on eliminating hepatitis C. Previous articles have reviewed patient testing, assessment, treatment and follow up after DAA treatment.4-7 This article summarises practical ways for GPs to eliminate hepatitis C in their individual practices. 

Microelimination in your practice

A useful approach for GPs to help achieve the goal of eliminating hepatitis C is ‘microelimination’. This is the concept that we as GPs can focus on pursuing hepatitis C elimination in our own practice or community.8 This involves some planning to tailor an approach for our individual clinic. An example of a hepatitis C elimination plan is shown in Box 1.9 

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Eliminating hepatitis C involves four steps: finding patients with hepatitis C, assessing, treating and following up. These steps can be achieved in four patient visits, with an optional fifth visit during treatment, as summarised in Box 2. Depending on patient circumstances, medical practitioners experienced in hepatitis C management may be able to achieve the steps in three visits. 

Find patients with hepatitis C 

There are two main groups of people with hepatitis C who need DAA treatment:10 

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  • people who are undiagnosed (estimated to be about 20%)
  • those who have been diagnosed previously with hepatitis C but remain untreated. 

Both groups are important to reach. 

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© KO STUDIOS
Dr Baker is a GP at East Sydney Doctors; and Senior Lecturer at the University of Notre Dame Sydney, Sydney, NSW. Dr Balcomb is a GP in Orange; and Honorary Lecturer at The University of Sydney, NSW. Dr O’Loan is a GP at Medeco Medical Centre Inala; Director of the Kombi Clinic; and Senior Lecturer at the University of Queensland, Brisbane, Qld. Dr Howell is a Consultant Gastroenterologist at St Vincent’s Hospital; Postdoctoral Research Fellow in Disease Elimination, Burnet Institute; and Postdoctoral Research Fellow in the Department of Medicine, University of Melbourne, Melbourne, Vic.