It’s time for action on Hepatitis C in New Zealand

“It’s time for action on Hepatitis C in New Zealand”– Hepatitis C can be eliminated.

Chronic Hepatitis C is a significant viral infectious disease which carries serious long-term implications for health. 50,000 people in New Zealand are living with chronic Hepatitis C, [1] of whom up to 30,000 may not know that they have it. [2] Symptoms are often non-specific, and many people are not tested until they develop serious consequences. [2] For those who live with chronic Hepatitis C infection, there is reduced quality of life and ongoing stigma for them and their families/whanau.

Every year in New Zealand, 1000 people contract Hepatitis C.[2] Since 2000, the numbers of people with severe liver scarring (cirrhosis) caused by Hepatitis C have doubled. This is because people with Hepatitis C are an ageing group, with low rates of diagnosis and very low treatment uptake (<1% per annum).[2] Hepatitis C is now New Zealand’s leading cause of liver transplants, due to liver cancer or complications of cirrhosis,[3] and one driver of the projected increase in deaths from liver cancer.[4] In 2014, approximately 140 New Zealanders died prematurely from consequences of the Hepatitis C virus, and by 2030 this number is expected to climb to 350.[2]

If the current low rates of diagnosis, assessment, and treatment are not dramatically improved, three times as many people are predicted to present with life-threatening complications of liver failure and liver cancer caused by Hepatitis C over the next two decades. [2] This increase would continue to reduce people’s quality and length of life, and also increase costs to New Zealand’s health system. Recent advances in treatments, diagnostic technologies, and methods for assessing the stage of disease, together with lessons learnt from recent pilot projects, suggest that an opportunity now exists to eliminate Hepatitis C in New Zealand by 2030.[2] Modeling shows that changing treatment strategies as soon as new treatments are available could substantially reduce morbidity and mortality, and that Hepatitis C could even be eliminated from New Zealand.[2] These strategies could also result in significant savings to the New Zealand health system, by avoiding direct and indirect costs. Delay in access to new therapies would have a tangible impact, resulting in more than 200 preventable deaths every year.[2]

Improved management of Hepatitis C in New Zealand must encompass a range of integrated strategies. Hepatitis C is a blood-borne virus; people who inject drugs are at greatest risk of contracting Hepatitis C. Measures to address Hepatitis C should include prevention via scale-up of access to sterile injection equipment, including in prisons. Universal implementation of safe practices for tattooing, body piercing, and other high-risk activities will be paramount. Testing and assessment programmes also need to target at-risk groups, with education and support for lifestyle changes, informed access to safe and effective treatment, and follow-up monitoring and care for liver cancer.

TARGETS

1. Develop a national action plan towards elimination of Hepatitis C in New Zealand.

2. Halve the current incidence rate by 2020, with enhanced awareness and prevention strategies such as scale-up of access to sterile injection equipment.

3. Diagnose and assess at least 80% of all people living with Hepatitis C by 2020, via targeted testing of at-risk groups, especially people who inject drugs.

4. Develop tailored strategies to improve services for Maori with Hepatitis C, including improved data collection.

5. Reduce access barriers to prevention, diagnosis, assessment, education, and treatment, particularly for high-risk groups.

6. Quadruple rates of treatment to 4,000 people every year by 2020, by providing access to interferon-free treatments.

7. Prevent the projected increase in Hepatitis C-related liver cancers, liver-related complications, and liver transplants by increasing treatment rates.

AbbVie New Zealand convened this workshop to develop a consensus statement and it was agreed by the following people:

References

1. Ministry of Health. Your health > Hepatitis C. Wellington, New Zealand; 2012. Available at http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis-c

2. Gane E, et al. Impact of improved treatment on disease burden of chronic hepatitis C in New Zealand. NZ Med J. 2014; 127(1407):61–74.

3. Australia and New Zealand Liver Transplant Registry. ANZLT Registry 25th Report. Brisbane, Australia; 2013. Available athttp://www.anzltr.org/Reports/25thANZLTRReport.pdf Accessed on 15/07/2015.

4. Ministry of Health. Cancer Projections: Incidence 2004–08 to 2014–18. Wellington: Ministry of Health; 2010. Available at http://www.health.govt.nz/publication/cancer-projections-incidence-2004-08-2014-18

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