Australia on Track to Achieve Who HCV Elimination Targets Following Rapid Initial DAA Treatment Uptake: A Modelling Study

Abstract

Background: Subsidized direct-acting antiviral (DAA) treatment recently became available to all adults living with chronic hepatitis C (HCV) in Australia. An estimated 32,600 people initiated DAA HCV treatment in 2016, an increase from 3,750 (IFN-based) in 2014. Based on this rapid uptake we estimated the impact on HCV epidemiology and mortality in Australia and determined if Australia can meet the WHO HCV elimination targets by 2030. Methods: Used a previously developed mathematical model, we simulated pessimistic, intermediate and optimistic DAA treatment scenarios in Australia over 2016-2030. We assumed treatment and testing rates were initially higher for advanced fibrosis and the same across HCV transmission risk level sub-populations. We compared the results to the 2015 level and a counterfactual (IFN-based) scenario. After 2016, we assumed testing rates and current harm reduction programs remained in place to focus on the impact of DAA treatment uptake. Findings: During 2016-2030, we estimated an intermediate DAA treatment scenario (2016, 32,600 treated; 2017, 21,370 treated; 2018,17,100 treated; 2019 and beyond, 13,680 treated each year) would avert 40,420 new HCV infections, 13,260 liver-related deaths (15,320 in viraemic; -2,060 in cured), and 10,730 HCC cases, equating to a 53%, 63% and 75% reduction respectively, compared to the IFN-based scenario. The model also estimated that Australia will meet the WHO targets of 80% reduction in HCV incidence by 2026 and 80% of eligible people treated by 2028. Time to a 65% reduction in liver-related mortality varied considerably between HCV viraemic only cases (2026) and all cases (2047). Interpretation: Based on a feasible DAA treatment scenario incorporating declining uptake, Australia should meet key WHO HCV elimination targets in 10 to15 years. Despite a reduction in liver-related mortality risk among those who are cured, the pre-DAA escalation in those with advanced liver disease makes the achievement of the liver-related mortality target difficult. Funding: NSW Health, as part of the BBV & STI Research, Intervention and Strategic Evaluation Program (BRISE), and the Australian Government. Declaration of interests: GJD is an advisory board member and receives honorarium from Gilead, Merck, Abbvie, Bristol-Myers Squibb, has received research grant funding from Gilead, Merck, Abbvie, Bristol-Myers Squibb, and travel sponsorship from Gilead, Merck, Abbvie, and Bristol-Myers Squibb. JG is a consultant/advisor and has received research grants from Abbvie, Cepheid, Gilead, Janssen, and Merck. CE and HR have received research grants from the John C Martin Foundation, Gilead Sciences, AbbVie, and WHO. RTG and JAK have provided project advice for Gilead.