the role of geographic mapping of viral hepatitis

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The Role of Geographic Mapping of

Viral Hepatitis -Monitoring the Care Cascade and Driving

Local Responses

Benjamin CowieDirector, WHO Collaborating Centre for Viral Hepatitis, Doherty [email protected] Viral Hepatitis ConferenceAdelaide SAAugust 14th 2018

The Peter Doherty Institute for Infection and Immunity

A joint venture between The University of Melbourne and The Royal Melbourne Hospital

Disclosures

I receive no funding or support of any kind from any pharmaceutical or for-profit health care related industry.

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Slide 3

Measuring Progress Towards Elimination -

No One Left Behind



Data for action

1. How can we measure progress towards viral hepatitis elimination?

2. What targets? What’s feasible?

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Data for action

1. How can we measure progress towards viral hepatitis elimination?

2. What targets? What’s feasible?

3. How do we use data to enable ACTION to stop people being left behind?



Slide 6

Hepatitis B Mapping Project: 4th National Report, 2018 Hepatitis C Mapping Project: 1st National Report, 2018

www.ashm.org.au/HBV/hepatitis-b-mapping-reports/ www.ashm.org.au/HCV/hepatitis-c-mapping-reports/

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National Viral Hepatitis Mapping Project

• Funded by the Australian Government

• Hepatitis B mapping from 2012 in partnership with ASHM

• Expanded to include hepatitis C from 2016

• Provide locally relevant, geographically specific estimates of the burden of disease and of access to treatment and care

• Identifying priority areas, progress, gaps and disparities



Questions we can answer• Which local areas in my catchment have the

highest burden of hepatitis C?

• Where should we target health workforce development to improve access to care?

• Who are the priority affected communities living with hepatitis B in my region? What languages do they speak?

• What is occurring with uptake of treatment and care over time – and over place?

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1. Identifying priority populations

Hepatitis B prevalence according to region of birth, 2016



1. Identifying priority populationsHepatitis C prevalence according to Primary Health Network, 2016

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2. Assessing disparities in progress Hepatitis B treatment uptake according to Primary Health Network, 2016

2. Assessing disparities in progress Hepatitis B treatment uptake according to SA3, Melbourne, 2016

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2. Assessing disparities in progress

Hepatitis C treatment uptake according to Primary Health Network, 2016



3. Identifying drivers of accessSpecialists per 1,000 people living with hepatitis B according to Primary

Health Network, 2016

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3. Identifying drivers of accessAssociation between hepatitis C treatment uptake

and other health indicators

25.0

27.0

29.0

31.0

33.0

35.0

37.0

39.0

41.0

43.0

45.0

5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Hepatitis C treatment uptake (%) compared to National Bowel Screening

Program Participation (% of eligible)

72

74

76

78

80

82

84

86

5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Hepatitis C treatment uptake (%) compared to average life expectancy

(years)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Mar 2013-Feb 2016Mar 2016-May 2016 Jun 2016-Aug 2016 Sep 2016-Nov 2016 Dec 2016-Feb 2017 Mar 2017-May 2017

Pro

po

rtio

n o

f p

eo

ple

re

ceiv

ing

tre

atm

en

t (%

)

ACT

NSW

NT

QLD

SA

TAS

VIC

WA

AUSTRALIA TOTALNational Viral Hepatitis Mapping Project - Hepatitis C

Slide 16

3. Identifying drivers of access

Prescribing of hepatitis C treatment by providers other than specialists

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3. Supporting the design and delivery of programs

• Health workforce education - ASHM

• Australian Government / Hepatitis Australia Hepatitis B Community Education grants

• Victorian Integrated Hepatitis C Nurses

• NT viral hepatitis service

• Priority languages for resources

• Estimates used in many presentations at this conference already!



4. Identifying success stories and model programs

• South Australia viral hepatitis nurses– Adelaide HCV treatment uptake

• South Western Sydney B Positive Program– Only PHN to achieve National Hepatitis B Strategy

Treatment target

• NT hepatitis B response – access to care / monitoring among highest in the country by PHN

• Increased focus on chronic hepatitis B in Far North Queensland

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Ongoing work

• CRC-SI work – geospatial analysis, predictors, associations with access to health care

• Health record linkage studies providing individual level of care, maintenance in care, outcomes

• Surveillance for Hepatitis B Indicators mathematical modelling modelling – what will be the future impact of treatment scale up now in your local area?

Slide 19



Slide 20

Surveillance for Hepatitis B Indicators –modelling

Tuesday 14 August 4.00pm – 5.30pmCity Room 2

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Making data WORK for elimination

Slide 21

1.37%

12.8%

29.5%

CHB treatment uptake by SA3

18.5%

18.3%

16.8%

14.0%

10.4%

10.2%

9.9%

6.8%

6.3%

ONLINE INTERACTIVE MAPPING REPORT DATA COMING TO A SCREEN

NEAR YOU SOON !!



Elimination of viral hepatitis is the goal

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Acknowledgements

WHO Collaborating Centre for Viral Hepatitis

VIDRL, Doherty Institute – Epidemiology Unit

Nicole Allard, Chelsea Brown, Benjamin Cowie,

Jennifer MacLachlan, Karen McCulloch,

Ashleigh Qama, Nicole Romero, Laura Thomas

Research & Programmatic Funding

Department of Health and Ageing, Australian Government

Department of Health and Human Services, Victoria

Melbourne Health Office for Research & RMH Foundation

Cooperative Research Centre for Spatial Information

Peter Doherty Institute for Infection and Immunity

www.doherty.edu.au/whoccvh



Download the Mapping Reports:

Hepatitis B

ashm.org.au/products/product/HepB-Mapping-Report-2016

Hepatitis C

ashm.org.au/products/product/HepC-Mapping-Report-2016

Visit us:

doherty.edu.au/whoccvh

For more information, contact:

[email protected]

the role of geographic mapping of viral hepatitis

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