Increase in routine hepatitis C RNA testing required to achieve elimination

26 June 2024

Untreated hepatitis C virus (HCV) infection is a major cause of liver disease, cancer, and premature death.  South Australia is in a position to become the first jurisdiction in Australia, and among the first in the world, to eliminate hepatitis C as a public health threat (PDF 4MB) Elimination requires the timely identification of longstanding untreated infections and re-infections occurring in previously treated patients with ongoing risk. Elimination also requires timely linkage of persons with active HCV infection to treatment.

HCV is easily treatable with direct-acting antiviral (DAA) agents listed on the Pharmaceutical Benefits Scheme (PBS). Listed DAA are pan-genotypic, oral, highly effective, and safe, with a short duration of therapy. HCV serology stays positive for life, hence, nucleic acid testing (NAT) for HCV RNA is required to confirm active infection and eligibility for DAA. Repeat provision of DAA is appropriate if reinfection occurs and PBS clinical eligibility criteria are met.

SA Pathology has commenced reflexive NAT testing on all samples that are HCV antibody reactive or indeterminate, if specimen volume is sufficient. Reflex testing decreases the burden on medical practitioners and patients and minimises delays between initial testing and treatment commencement.

Medical practitioners are advised to:

• Routinely screen for HCV infection in persons at risk, as detailed in the table below.
• Regularly repeat testing if a patient has ongoing risk factors:
  • Repeat serology in screen-negative patients with a request for reflex testing (see below).
  • Order HCV RNA NAT in patients who previously had HCV infection successfully treated.
  • See ASHM testing portal for recommended testing frequencies by risk type.
• If ordering serology, request ‘HCV serology and if positive, HCV RNA NAT’ and collect both serum (gold top) and a dedicated blood specimen in EDTA (+/- gel).
• Notify patients with hepatitis C to the CDCB by phone on 1300 232 272 if the infection was likely acquired in the past 2 years or if public health advice is required; otherwise download and fax the blue notification form (PDF 780KB) to (08) 7425 6696.
• Be aware the CDCB refers all new notifications of HCV infection to SA Health Viral Hepatitis Nurses, who contact diagnosing medical practitioners and patients to offer support regarding follow-up and provision of treatment, where required.
• Consider clinical audits to identify patients for whom HCV testing is indicated as a practice quality improvement activity in line with new CPD requirements. Refer to ASHM and INHSU resources.
• Provide information to patients on hepatitis C as needed. See www.hepatitissa.asn.au and www.sahealth.sa.gov.au/youvegotwhat.

High-risk settings or situations

• Injecting drug use (current or past)
• Incarceration (current or past)
• Tattoos or body piercing with poor infection control procedures
• Men who have sex with men
• Sexual partners of a person with HCV infection
• Children born to mother with HCV infection
• Born in places with high prevalence of HCV (the Middle East, the Mediterranean, Eastern Europe, Africa, and Asia)
• Needlestick injury.

Clinical conditions

• Abnormal liver function tests
• Acute hepatitis
• Chronic liver disease or liver cirrhosis
• Hepatocellular carcinoma
• Presence of conditions associated with HCV:
  • porphyria cutanea tarda
  • vasculitis
  • cold agglutinin presentations
• HIV or hepatitis B infection
• On regular haemodialysis
• Received blood transfusion or organ transplant before 1990
• Received blood products or plasma-derived clotting factor treatment products for coagulation disorders before 1993

For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)
Dr Louise Flood – Deputy Director, Communicable Disease Control Branch