Modelling the hepatitis C virus epidemic in Australia.

BACKGROUND: Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and consequently the number of new hepatitis C infections in Australia. This paper updates estimates of HCV incidence and prevalence between 1960 and 2005. METHODS: Simple mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population. RESULTS: The modelled best estimate of past HCV incidence showed a consistent increasing rate of HCV infections to a peak of 14,000 new seroconversions in 1999, followed by a decline in 2001-2002 coincident with the decline in heroin availability. HCV incidence was estimated to be 9700 (lower and upper limits of 6600 and 13,200) in 2005. Of these, 88.7% were estimated to be through injecting drug use, 7.2% among migrants and 4.1% through other transmission routes. An estimated 264,000 (lower and upper limits of 206,000 and 318,000) people were HCV antibody positive in 2005. CONCLUSIONS: Mathematical models suggest that HCV incidence in Australia decreased from a peak of 14,000 new infections in 1999 to 9700 new infections in 2005, largely attributable to a reduction in injecting drug use. The numbers of people living with HCV in Australia is, however, estimated to continue to increase.

Evidence for the effectiveness of a chlamydia awareness campaign: increased population rates of chlamydia testing and detection.

The objective of this study was to determine the effectiveness of a statewide campaign aimed at increasing chlamydia awareness and testing among younger people. In November 2002, a narrowcast media campaign targeting men and women aged 16-29 years was launched in Victoria, Australia. This was expanded in June 2003. Data on chlamydia testing via Medicare and chlamydia notifications, before and after the campaign, were compared to determine possible effects of the campaign on population rates of chlamydia testing and detection. During the campaign, chlamydia testing rates increased significantly for both women (P=0.04) and men (P=0.04), while testing rates before and after the campaign remained relatively stable. Although testing rates increased, only 4.3% of Victorian women and 1.9% of men aged 16-30 were tested through Medicare in 2003. The increase in chlamydia testing over the study period was closely paralleled by an increase in notification rates for chlamydia, with strong correlations between the two (r=0.97, P<0.001). In conclusion, an estimated minimum of A$70 was spent on the campaign for each additional chlamydia test performed. Testing within the framework of a national chlamydia screening programme may be a more cost-effective way of increasing chlamydia testing.

Evaluation of a prison-based hepatitis B immunisation pilot project.

This paper describes the evaluation findings of a hepatitis B immunisation pilot project, which aimed to increase the uptake and compliance of hepatitis B vaccinations among female prisoners in Victoria. The evaluation used a mixed methods approach including in-depth interviews, focus group discussions and an analysis of quantitative data. Fifty-five per cent of potential participants (391/712) were offered hepatitis B immunisation. Of those offered immunisation, 204 were eligible for immunisation and 169 (83%) received the first dose. Ninety-three per cent of eligible women received two doses and 84% completed the three-dose series. Lessons learnt from the pilot led to the revision of key prison hepatitis B immunisation policies and practices to ensure uniformity across Victorian prisons.

Exploring the need for hepatology nurses and allied health professionals in Victorian liver clinics.

OBJECTIVE: To examine the need for hepatology nurses and allied health professionals in Victorian liver clinics to meet the increasing demand from people seeking treatment for hepatitis C infection. DESIGN: We reviewed the literature, analysed data from nine Victorian liver clinics, and conducted a qualitative rapid assessment with key stakeholders including hepatology nurses. PARTICIPANTS: Fourteen key stakeholders including clinicians and directors of liver clinics were invited to take part in interviews; two declined to participate. All ten members of the Victorian Hepatology Nurses Group were invited to participate in a focus group discussion, and six attended. RESULTS: Participants reported that hepatology nurses played a critical role in improving treatment uptake and compliance, in particular, in educating, counselling and managing treatment for people with hepatitis C infection. Psychiatric and social work staff assisted patients to overcome side effects associated with treatment. Interpreters increased access for those from culturally and linguistically diverse communities. CONCLUSIONS: Hepatology nurses and allied health professionals are central to enhancing treatment outcomes for people who are infected with hepatitis C. Further research is necessary to estimate the number of nurses and allied health professionals required to meet the current and future needs of people receiving treatment for hepatitis C infection.