How to prescribe treatment
Prescribing fast facts
- The newer drugs, Directly Acting Antivirals (DAAs) are safer and more effective than the older peginterferon-based drugs; are available in tablet form in short courses, and available on the PBS
- Anyone over 18 with a Medicare card is eligible for treatment, regardless of current or past injecting
- General practitioners can prescribe the new medicines by becoming familiar with the management of hepatitis C
- Those not confident to prescribe can seek a GP mentor or refer for specialist review
- Collecting basic information on patients and conducting basic blood tests, virology tests and liver fibrosis tests allows treatment to commence
- Authorisation to prescribe requires simple communication with a specialist, using the template provided
- Treating 'contacts' of current patients is a critical step in helping to eliminate hepatitis C as a public health problem.
Considerations before prescribing DAAs
General practitioners may prescribe DAAs for those with uncomplicated chronic hepatitis C infection, defined by the conditions below:
- investigations suggest no evidence of cirrhosis (liver stiffness on FibroScan® <12.5 kPa or APRI <1.0)
- no co-infection with hepatitis B or HIV
- not previously treated with DAAs
- No contraindications
Refer to a specialist clinic if any of the above is not met or if the patient has complex comorbidities.
Information on training for GPs to manage hepatitis C is available in Resources for Clinicians.
Refer to the Australian recommendations for the management of hepatitis C virus infection: Consensus statement 2017 for detailed guidance on assessment, treatment and monitoring.
To download a wall chart for GPs summarising guidelines for treating hepaitis C virus infection including checklists for pre-treatment assessment, click here.
Authorisation: As of October 2016, general practitioners who are experienced in prescribing DAAs, can prescribe without specialist consultation. To get authorisation to prescribe, you must complete a Primary Care Consultation Request: Initiation of Hepatitis C Treatment. Templates are available through many HealthPathways websites or in a soft copy version for printing (for Victoria) here.
- Specified specialists include gastroenterologist, hepatologist, or infectious disease physician experienced in the treatment of chronic hepatitis C infection.
- In the short term, this is likely to be via liver, infectious disease or gastroenterology clinics.
- Contact the Authority Prescription Application Service on 1800 888 333 with required information for approval to prescribe DAAs.
If you are not (or not yet!) confident with prescribing DAAs, consider referring a newly-diagnosed patient to a hepatitis specialist for further assessment, consideration of therapy, and determination of a management or monitoring plan. Go to the Clinic Finder for help in finding a specialist service.