The reasons why the health care system has failed to effectively deal with the HCV epidemic are multifactorial and include the toxicity of IFN-based-antiviral therapy, insufficient linkage to tertiary hospital-based care for socially marginalised individuals, capacity constraints in tertiary care and a lack of alternative models of care. The introduction of new DAA regimens is a major advance for HCV therapy. Their high efficacy, short duration and excellent tolerability mean that most people will now be suitable for treatment, that most people who start treatment will be cured, and that treatment will be possible in the community as well as in specialist centres.
The PBS listing allows the new HCV medicines to be prescribed by a medical practitioner experienced in the treatment of chronic HCV infection, or in consultation with a gastroenterologist, hepatologist or infectious diseases physician experienced in treating chronic HCV infection. This means that general practitioners are eligible to prescribe under the PBS in consultation with one of these specialists. “In consultation with” means that a GP must consult with one of the specified specialists by phone, fax, mail, email or videoconference in order to meet the prescriber eligibility requirements. Once GPs are experienced in treating chronic HCV infection, they may prescribe independently (see Treatment by general practitioners in primary care). The Pharmaceutical Benefits Advisory Committee (PBAC) has recently expanded the criteria for prescribing the new DAA treatments through the PBS General Schedule (Section 85) to include authorised nurse practitioners experienced in the treatment of chronic HCV infection. This initiative will increase the timely, affordable and equitable access to treatment in Australia.
The new HCV medicines are available through the PBS General Schedule, as well as the Section 100 Highly Specialised Drugs (HSD) Program. This means that approved pharmacists in the community can dispense the new HCV medications. The S100 listing makes provision for treatment of prisoners through the HSD Program. The S85 provision for community dispensing of DAA therapy prescribed by GPs is intended to increase capacity to allow upscaling of treatment rates to the desired level for reducing population burdens of HCV and secondary liver disease and for achieving the ambitious target set by the World Health Organization of HCV elimination by 2030. The development of new models of care for HCV treatment will be necessary to achieve these goals. Suggested models of care for this new era are outlined below.