Viral hepatitis notifications: a cohort study of enhanced local follow-up in Victoria

Objectives: Australia needs to increase linkage to viral hepatitis care and treatment to achieve the 2030 elimination targets. This study assessed the intervention of enhanced local public health (PH) follow-up of hepatitis B and hepatitis C notifications on linkage to care and treatment, compared to standard PH management, in the Barwon South West (BSW) and Gippsland regions in Victoria. Importance of study: Innovative models to increase viral hepatitis testing and linkage to care and treatment are required, especially in regional Australia. Study type: Retrospective cohort study. Methods: Study periods were March–August 2022 (standard PH management), and September 2022–February 2023 (enhanced local PH follow-up). Notifications from correctional facilities were excluded. Outcomes by study period compared time to complete hepatitis C diagnosis, hepatitis C treatment initiation, hepatitis B viral load measurement and referral for hepatitis B care. A Kaplan-Meier survival analysis and Cox regression model was performed. Results: 190 notifications met inclusion criteria and 174 people were included in the analysis - 133 with hepatitis C and 41 with hepatitis B (16 were lost to follow-up). The probability of having an incomplete hepatitis C diagnosis within 180 days from notification was 2.33 (95% CI 1.40, 3.89) times higher among patients receiving standard PH management compared to enhanced local PH follow-up. The probability of not being referred to hepatitis B care within 90 days from notification was 2.78 times (95% CI 1.13, 6.82) higher among patients receiving standard PH management compared to enhanced local PH follow-up. Conclusions: Enhanced local PH follow-up increased the proportion of hepatitis C notifications with a complete diagnosis and hepatitis B notifications referred to care. Local PH follow-up presents a unique opportunity to accelerate progress towards the 2030 viral hepatitis elimination targets in Victoria.