Policy on hepatitis C testing revised
Hepatitis C infection is a major public health problem in Australia.
It is estimated that more than 280,000 people have been exposed to the hepatitis C virus (HCV) since testing began in 1990 and that a further 10,000 acquire the infection each year.
Influenced by multiple factors, infection persists in between 55% and 85% of those infected. Cirrhosis develops within 20 years in 5% to 10% of this group (usually associated with other co-morbidities such as co-infection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV), obesity, insulin resistance, alcohol intake > 40gm/day) and in a further 10%–15% after 40 years.
Hepatocellular carcinoma will develop in 3% to 5% of people per annum who develop cirrhosis. Preventative and therapeutic interventions have proven effective in lowering HCV transmission and improving quality of life and clinical outcomes for people with HCV.
HCV testing provides people with information about their contact with the virus. Appropriate testing indicates whether they have cleared the virus spontaneously or with antiviral therapy, or have an ongoing (active) chronic infection.
The benefits of reliable, timely testing are numerous, both for the patient and public health. Detection of HCV infection followed by appropriate education can:
- reduce onward transmission by empowering people with HCV to modify their behaviour
- modify progression of the disease through earlier referral for advice and/or treatment
- protect blood, tissue and organ donation supplies.
Despite the public health and individual benefits of testing, a significant but as yet undocumented number of infected people in Australia remain undiagnosed.
It is therefore crucial that clinicians who obtain informed consent and provide hepatitis C test results have the skills and knowledge to fully communicate the significance of each of the available tests to the person being tested.
A revised national policy on HCV (external site) was released recently and contains significant differences from the previous 2007 policy including:
- a change in terminology from pre-test discussion to informed consent
- a change in the way HCV-negative test results are communicated to patients
- web-based provision of policy allowing for regular revision to provide consistent management of emerging technologies such as Point of Care testing and viral resistance testing
- access to related resources such as related policies, operational guidelines and evidence of best practice.
Training on caring for patients with hepatitis C and B (external site) is available free online.