Policy context

Policy and strategies aimed at controlling major risk factors such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections have significant potential to reduce Australia's current and future liver cancer burden.

As described in the Prevention and Screening sections of this chapter, the impact of HBV and HCV in Australia has been successfully reduced through ensuring a safe blood supply, implementing a national HBV immunisation program and making treatments for chronic HBV and HCV available through the Pharmaceutical Benefits Scheme.

National strategies and guidelines

Australia has a number of national strategies for hepatitis control, and was the first country in the world to have a national strategic response to hepatitis C. Major frameworks include:

• Fifth National Hepatitis C Strategy 2018–2022;
• Third National Hepatitis B Strategy 2018–2022;
• National Hepatitis C Testing Policy ; and
• National Hepatitis B Testing Policy

These frameworks, while broadly supported in principle, are not underpinned by implementation plans, systematic reporting and auditing and direct program funding related to specific services.

Hepatitis B and hepatitis C infections are notifiable conditions; however, under-diagnosis and under-reporting of HBV and HCV infections mean that hepatitis incidence and hepatitis-related disease burden are underestimated ^[1][2]. Current prevalence estimates rely on antenatal screening data, opportunistic laboratory surveys, and estimates of at-risk populations.

Hepatitis B vaccination

Routine adolescent HBV vaccination was introduced in 1997, and universal infant vaccination began in 2000. Uptake among Australian children is high; 96% of children aged 24 months of age at 30 September 2015 had received the full course (three doses) (NCIRS 2018)^[3]. Hepatitis B birth dose is also recommended for all infants born in Australia; current uptake is not systematically reported nationally. Hepatitis B immunoglobulin is recommended in addition to birth dose vaccination to newborns of mothers with HBV infection and is around 85–95% effective in preventing vertical transmission^[4][5][6][7]. National coverage of HBV immunoglobulin among infants born to women living with chronic HBV is not known.

HBV vaccination is recommended for susceptible adults in high-risk groups, such as close contacts of a person with hepatitis B, migrants from endemic countries and Aboriginal and Torres Strait Islander Australians^[8] and those who are unvaccinated. However, there is no systematic approach to ensure these high-risk groups are vaccinated.

Screening programs

Australia does not have population-based screening programs for HBV, HCV or liver cancer as currently there is insufficient evidence to support such programs in Australia (See Principles of screening). However, there is evidence to support targeted screening in priority populations ^[9]. Mandatory or compulsory hepatitis testing is required under policy or legislation for people wanting to participate in certain activities or have access to certain services, e.g. as a condition of blood, tissue and organ donation; to enter armed forces training or service; and before performing exposure-prone procedures in some healthcare settings. National HBV and HCV testing policies have identified ‘priority populations’^[10] for testing such as people born in countries of high HBV prevalence. ^[11]

Treatment of hepatitis B and C

Antiviral treatments are available for HBV and HCV infections. Treatment of HBV, which must continue indefinitely for most individuals, substantially reduces the risk of liver cancer in those treated within a few years of initiation. ^[12] Treatment of HCV is curative in approximately 95% of individuals after 12 weeks of oral antiviral treatment, which has been available on the PBS since March 2016. These HCV treatments have also been associated with substantial mortality benefit and prevention of liver cancer in those treated ^[13].