Hepatitis B and C: the patients general practice is still missing

What just happened

World Hepatitis Day was 28 July. Four days later, we are still in that window — and a new Healthed episode released last week, syndicated through The Medical Republic, asks a question that is worth sitting with: if we have a cure for hepatitis C, why are tens of thousands of Australians still living with it undiagnosed?

Associate Professor Paul Gow, gastroenterologist and hepatologist, joins GP educator Dr Marita Long to walk through the practical answer — which is less about the medicine and more about the systems. Specifically: how general practice identifies, tests, and engages the people most likely to have viral hepatitis and least likely to know about it.

This is a familiar tension in public health. The tools exist. The treatment works. The gap is in finding the patients. And general practice is where most of them eventually pass through.

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Both-and

Hepatitis C is curable — and this is genuinely extraordinary

To be clear about what the treatment landscape looks like in 2026: chronic hepatitis C is now curable for the vast majority of people who receive treatment.

Direct-acting antivirals — glecaprevir/pibrentasvir (Maviret) and sofosbuvir/velpatasvir (Epclusa) — are PBS-listed, taken once daily for eight to twelve weeks, and achieve sustained virological response (SVR) — meaning undetectable virus at twelve weeks post-treatment, effectively a cure — in over 95% of people across all hepatitis C genotypes. They are tolerated well by most patients, with few significant drug interactions.

Critically, GPs and nurse practitioners can now prescribe these without specialist referral. That removed one of the largest access barriers in the previous treatment era. A GP who diagnoses hepatitis C at a consultation can, in most cases, initiate treatment at the next appointment.

More than 68,000 Australians are still living with chronic hepatitis C, and a significant proportion remain undiagnosed. These are people who will eventually develop liver complications — cirrhosis, liver failure, hepatocellular carcinoma — from a condition that is now eminently treatable. The infrastructure for cure exists. The gap is the diagnosis.

Hepatitis B: a different problem, the same gap

Hepatitis B presents a more complex clinical picture. Unlike hepatitis C, chronic HBV is not curable with current therapy. Oral antivirals — tenofovir (TDF or TAF) and entecavir — are PBS-listed and suppress viral replication effectively, but they do not eradicate the virus and typically require long-term or indefinite treatment in those with chronic active infection.

What treatment does achieve is significant: sustained viral suppression substantially reduces the risk of liver cirrhosis and hepatocellular carcinoma — one of the most preventable cancers in people with chronic HBV. It also prevents transmission to household and sexual contacts. And a diagnosed patient can be enrolled in regular monitoring, where clinical decisions about treatment timing and surveillance for liver complications can be made systematically.

The ASHM has noted that Australia is a decade behind its hepatitis B elimination targets, with a substantial proportion of the estimated 220,000 Australians living with chronic HBV remaining undiagnosed. The highest-risk populations include people born in countries with high hepatitis B prevalence — particularly in South-East Asia, Sub-Saharan Africa, and the Pacific Islands — as well as Aboriginal and Torres Strait Islander people, people with a history of injecting drug use, and healthcare workers.

Why is general practice where this happens?

Because most of these patients are already in the health system — they see GPs for other reasons. A woman born in Vietnam attending for a cervical screening test. A man born in PNG attending for a diabetes review. A person with a history of injecting drug use attending for a mental health care plan.

The ASHM testing protocols are systematic precisely because the history matters and risk is not always volunteered. Asking about country of birth, family history, blood transfusions, tattoos, and past drug use is a clinical act, not an intrusion. When it is framed as routine care — “we check for hepatitis in anyone with these background factors, the same way we check cholesterol at a certain age” — uptake is higher and the encounter is less fraught.

Hepatitis C testing has been simplified considerably: an anti-HCV antibody test identifies prior exposure, and reflex HCV RNA testing on a positive sample confirms current active infection. The whole cascade can be initiated from a single blood draw. For hepatitis B, the recommended panel is three tests — HBsAg, anti-HBs, and anti-HBc — ordered together.

The Beyond the C program

Beyond the C is an Australian Centre for Disease Control–funded program specifically designed to help general practices systematically identify undiagnosed hepatitis C in their patient population. It uses a structured audit approach — searching existing patient records for risk factors, identifying eligible patients who have not been tested, and supporting test-and-treat pathways.

Practices that complete the program receive $4,000 in funding (in two instalments). Beyond the financial incentive, the program gives practices a structured mechanism for doing what the Healthed episode is recommending: systematically finding the patients who already exist in the practice’s records but whose hepatitis C status is unknown.

If your practice has not looked at this program, it is worth reviewing.

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My two cents

The reason viral hepatitis is still undertreated in 2026 is not a treatment gap. It is a detection gap. And detection requires a question to be asked.

That question is harder to ask than it should be, because it requires surfacing histories that carry stigma. Injecting drug use. Sex work. Incarceration. Country of birth in an era when endemic infection was not well managed. These are not neutral topics in a ten-minute consultation, and the social conditions around them shape who feels comfortable answering honestly.

What helps, consistently, is normalising the test. “We routinely check hepatitis B and C in people born in certain countries” removes the personal targeting. “We recommend everyone who has ever used injecting drugs get tested once, regardless of how long ago” gives it a clinical rationale that takes the inquiry out of judgement territory.

General practice is where Australia’s hepatitis elimination targets are either met or missed. Not in hospital clinics. Not in specialist hepatology waiting rooms. In the GP consultation where someone has come in for something else entirely.

The test is cheap, the treatment works, and the consequence of missing it — silent cirrhosis, hepatocellular carcinoma presenting late — is not.

Verdict: yes — risk-based hepatitis B and C testing in general practice is evidence-supported, the treatment infrastructure exists, and the Beyond the C program gives practices a structured way to act. Worth putting on the agenda at the next practice meeting.

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Sources cited

1. Gow P. Hepatitis B and C: Finding the patients we’re missing. Healthed (via The Medical Republic), 30 July 2026. https://www.medicalrepublic.com.au/hepatitis-b-and-c-finding-the-patients-were-missing/127817
2. ASHM National HCV Testing Policy. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. https://testingportal.ashm.org.au/national-hcv-testing-policy/
3. Beyond the C: National Hepatitis C Elimination Program for General Practice. https://www.beyondthec.com.au