Embedding hepatitis C testing in key settings to prevent liver cancer

Overview

Hepatitis C is a blood-borne virus which can lead to liver fibrosis, cirrhosis and cancer if left untreated. Hepatitis C disproportionately affects people who inject drugs or have previously injected drugs, people in custodial settings and Aboriginal and Torres Strait Islander people. The NSW Hepatitis C Strategy (2021-2025) has a goal to increase hepatitis C virus testing and treatment uptake to reduce morbidity and mortality, including liver cancer. There is a target to reduce hepatitis C attributable mortality including liver cancer by 50% by 2025.

By embedding hepatitis C testing into services attended by priority populations (including alcohol and other drug (AOD) services, correctional facilities and needle and syringe programs), people are diagnosed earlier and can commence treatment before liver damage occurs. The NSW Health “Hepatitis C Testing and Care in Alcohol and Other Drug Services” Guidance Document provides a framework for scaling up hepatitis C care in AOD settings. The guidance outlines minimum standards for testing and treatment, supports workforce development, and strengthens partnerships between AOD services and hepatitis teams.

NSW Health has implemented alternative testing technologies, including Dried Blood Spot (DBS) and point-of-care testing to reduce barriers to testing. The DBS Project is a clinical trial to expand access to hepatitis C testing in non-clinical settings through finger-prick blood samples to reduce barriers to venepuncture for people with poor venous access. NSW Health is also participating in the Australian Hepatitis C Point-of-Care Testing Program, led by the Kirby Institute, UNSW, to further expand access to rapid hepatitis C testing. This program supports the use of point-of-care technologies in high-prevalence settings to provide same-day diagnosis and linkage to care.

Evaluation methodology

The NSW Hepatitis C Strategy (2022-2025) has an evaluation framework to monitor progress towards elimination. Performance is assessed across four strategic goals: prevention, testing, treatment, and reducing stigma and discrimination. There is a target to reduce hepatitis C attributable mortality including liver cancer by 50% by 2025.

Progress is tracked using key performance indicators (KPIs) embedded in Local Health District (LHD) service agreements and through annual and quarterly data reporting. The Centre for Population Health monitors implementation by reviewing service delivery outcomes from LHDs and non-government organisations (NGOs), supported by data from NSW Health Pathology, the Pharmaceutical Benefits Scheme, and other surveillance systems.

Governance of the Strategy is overseen by the NSW Hepatitis C Strategy Implementation Committee, which provides expert advice and leadership. Data advisory committees and stakeholder consultations contribute to refining models of care, improving data completeness, and ensuring equitable access to testing and treatment for priority populations.

Key findings

NSW has made substantial progress in scaling up hepatitis C testing and treatment, contributing to reductions in liver-related cancer.

In 2024, testing increased across NSW, supported by innovative technologies and service models.

• Over 24,000 hepatitis C RNA tests were completed in key settings, including 5,371 DBS tests and 2,953 point-of-care tests.
• Over 3,000 hepatitis C treatments were dispensed including 1,239 treatments dispensed in Justice Health settings.
• Importantly, liver-related mortality in NSW declined by 15% between 2015 and 2022, reflecting the impact of expanded hepatitis C treatment access and early diagnosis.

Continued efforts to embed testing in priority settings and improve linkage to care are essential to achieving hepatitis C elimination and reducing the burden of liver cancer.
 

Opportunities

NSW has a unique opportunity to achieve the elimination of hepatitis C as a public health concern and reduce hepatitis C-attributable mortality and morbidity due to liver cancer. Alternative testing technologies such as DBS and point-of-care improve access to care for populations who face barriers to traditional healthcare, including people who inject drugs, individuals in custodial settings, and those accessing needle and syringe programs. Embedding testing into Alcohol and Other Drug (AOD) services, prisons, and outreach programs support earlier diagnosis and treatment, directly contributing to liver cancer prevention.

What is next?

In early 2025, NSW Health Pathology and the NSW Ministry of Health submitted an application to the Therapeutic Goods Administration (TGA) for the use of DBS testing as a diagnostic tool for hepatitis C outside of a research framework. If approved, this will enable broader implementation across priority settings. Integrating DBS testing into routine practice and increased use of point-of-care testing will significantly expand access to and earlier hepatitis C diagnosis and treatment, for people with barriers to venepuncture or traditional healthcare.

The NSW Ministry of Health will continue to support LHDs to embed hepatitis C testing into routine care, guided by clinical leads and peer networks.

Supporting documents

• Hepatitic C Testing and Care in Alcohol and Other Drug Services (PDF)
• NSW Hepatitis C Strategy 2022-2025 (PDF)