An estimated 271,000 people had been infected with hepatitis C virus (HCV) in Australia by 2006, with around 200,000 having chronic HCV infection. Of the 40,000 people on opiate dependency pharmacotherapy in Australia, an estimated 70-75% will have been infected with HCV, with 50% (20,000) having chronic HCV infection. Many of these people have been infected with HCV for greater than 20 years, thus an increase in the burden of advanced liver disease is expected over the next decade.

HCV treatment has improved in recent years, particularly since the advent of pegylated interferon and ribavirin combination therapy, with 50%-80% (depending on HCV genotype) of people now achieving a sustained virological response (cure) following 24-48 weeks therapy. These general improvements in HCV treatment outcomes have also been seen in studies among people with chronic HCV on opiate dependency pharmacotherapy. There has been an increase in HCV treatment uptake since the removal of mandatory liver biopsy in April 2006, however, only 3,500 people with chronic HCV infection in Australia receive therapy each year. This low uptake of HCV treatment is particularly seen in settings such as opiate pharmacotherapy clinics where other medical and psychological co-morbidities are common among individuals with HCV, and HCV clinical services are limited due to lack of dedicated resources, competing clinical priorities, and limited specific HCV education and training.

The Enhancing Treatment of Hepatitis c in Opiate Substitution settings (ETHOS) project is a NSW Health funded initiative to establish and enhance HCV treatment in several opiate dependency pharmacotherapy clinics in NSW. An associated ETHOS Cohort Study will examine factors associated with HCV treatment assessment, treatment uptake and outcomes within these clinics. A Commonwealth Government funded project is also undertaking education and training of health care workers in the alcohol and other drug sector. Considerable investment in HCV clinical services in these settings will be require to improve HCV treatment uptake and limit the anticipated expanding burden of advanced liver disease.