Monitoring hepatitis C treatment uptake in Australia: Issue #13, July 2023
Bibliographic record
Abstract
A total of 105,024 individuals have initiated direct acting antiviral (DAA) treatment for chronic hepatitis C virus (HCV) infection in Australia, including 100,684 individuals through Pharmaceutical Benefits Scheme (PBS) during 2016 to 2022, and an estimated 4,340 individuals through early DAA access avenues in 2014-15. In 2022, 5,205 individuals initiated treatment (first course), increasing from 1,141 in the first quarter to 1,432 in the last quarter of 2022. The recent increase in treatment uptake could be explained by enhanced HCV testing programs implemented in the community and prisons in several jurisdictions. Among individuals initiating DAA treatment during 2016 to 2022 (n=100,684), 68% were men, and median age was 47 years (quartiles 1-3: 38-57). Since August 2018 when both pan-genotypic regimens were available (i.e., sofosbuvir/velpatasvir and glecaprevir/pibrentasvir), 53% of individuals have been initiated on sofosbuvir/velpatasvir, 41% on glecaprevir/pibrentasvir, and 6% on other regimens. Most individuals initiating DAA treatment received their prescriptions from general practitioners (GPs; 46%), followed by gastroenterologists (35%). Overall, 52% of individuals were initiated on treatment by specialists, and 48% by non-specialists (i.e., GPs and nurse practitioners). A total of 2,048 individuals were initiated on treatment by nurse practitioners, increasing from 92 in 2017 to 535 in 2022. Among individuals initiating DAA treatment during 2016 to 2022, 8.6% discontinued treatment, including 4.0% early discontinuation (i.e., dispensed 28 days of treatment) and 4.6% late discontinuation (i.e., dispensed at least 56 days of treatment, but not all recommended duration). The proportion of early discontinuation increased from >3% in 2016 to 8.5% in mid-2021 followed by a plateau phase and then slight decrease in 2022. Among individuals who discontinued treatment, 26% received re-treatment. Among individuals initiating DAA treatment during 2016 to 2022, 8.5% received at least one course of re-treatment. Among re-treatment initiations, an estimated 57% were for HCV re-infection and 43% for treatment failure. The number of re-treatment initiations for treatment failure increased during the second quarter of 2019, corresponding to sofosbuvir/velpatasvir/voxilaprevir availability through PBS (April 2019), and has decreased since. The number of re-treatment initiations for HCV re-infection increased until mid-2020, stabilised during 2020-21, and increased again in 2022. This latest increase could be the result of enhanced HCV testing programs implemented in several jurisdictions through which many individuals with HCV re-infection were diagnosed and linked to clinical care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.002 | 0.003 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.021 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".