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World first research program ASCEND is designed to improve access to hepatitis C treatment for people who inject drugs and potentially eliminate the virus among this population.

The five-year research program is being run jointly by The National Drug and Alcohol Research Centre (NDARC) and The Kirby Institute at UNSW Sydney and is funded by a $9 million National Health and Medical Research Centre (NHMRC) program grant, which commenced in January 2019.

More than half of the 93,000 Australians who have recently injected drugs are living with hepatitis C. The Australian Government provides hepatitis C treatment through the Pharmaceutical Benefits Scheme (PBS) and is one of the only countries in the world to offer the treatment for free regardless of their stage of liver disease or injecting status.

A key focus of the research is to improve drug treatment options and accessibility for people who inject drugs at the same time as increasing their access to hepatitis C treatment.  

An early initiative, under the umbrella of ASCEND, is an open label multicentre trial of monthly injectable buprenorphine (CoLAB) that has recently commenced. Chief investigator of CoLAB and joint chief investigator of ASCEND, Professor Michael Farrell, said monthly injections offered an exciting potential to increase patient retention and free up resources to improve treatment access.

“In settings such as Australia, where there is a focus on supervised daily dosing, the reduced frequency of dosing required for a monthly buprenorphine injection may free up service-level resources currently allocated to patient monitoring and potentially increase treatment capacity,” said Professor Farrell.

Professor Greg Dore, head of the Kirby Institute’s Viral Hepatitis Clinical Research Program and joint chief investigator of the ASCEND program, said that in order to eliminate hepatitis C in Australia it was vital to engage with hard to reach populations, in particular those who are in prison.

“One in five prisoners in Australia are chronically infected with hepatitis, yet very few of these people are undergoing treatment,” said Professor Dore.

“As part of the ASCEND program we’ll design and evaluate a one stop shop intervention that uses innovative finger-testing for hepatitis C on entry into prison. This will allow us to quickly initiate treatment in those who are positive. This will dramatically improve the health of prisoners, but also, it will reduce the risk of onward transmission in prison.”

The program is working closely with the affected communities including The Australian Injecting and Illicit Drug Users League (AIVL).

Professor Dore said that every individual living with hepatitis C has a right to treatment.

“For many people hepatitis C cure provides closure in relation to past drug use,” said Professor Dore.

“Equally important, for people who continue to use drugs, hepatitis C cure provides improved quality of life and often a feeling of optimism within a complex social and health context.”

More information about CoLAB can be found here. More information about ASCEND can be found here.