Hepatitis C Summit
Last month the second Hepatitis C Summit was held in Aotearoa, to coincide with World Hepatitis Day on 28 July. Health professionals and people with lived experience of the hepatitis C virus (HCV) met to discuss the prevalence, impact and solutions in Aotearoa. Ashley Koning shares some insights from the summit.
Each year 1.45 million lives are lost due to hepatitis C, and viral hepatitis is now the tenth most common cause of death globally.
The Ministry of Health estimates that approximately 50,000 New Zealanders are affected by HCV. People who inject drugs or have done so in the past, and people with mental health issues are more at risk of having HCV.
However, many people do not know they have HCV as they can have few, if any, clear symptoms for many years. It has been estimated that about half of the people with HCV in Aotearoa (around 25,000 people) are unaware that they have HCV. Untreated HCV can lead to the development of cirrhosis of the liver and liver cancer, and HCV is the leading cause of liver transplantation in New Zealand.
Over the past few years, new treatments have emerged that can cure HCV for at least 90% of people with the virus. The World Health Organisation believes that as a consequence HCV can be eliminated worldwide by 2030. In Aotearoa, Pharmac have funded treatment for the most common form of HCV for the past two years. Newer regimes will soon be available that can successfully treat all versions of HCV.
With the availability of safe, effective and cost-effective treatment - the barriers to people accessing lifesaving treatment are:
- the political will
- people being unaware that they have been exposed to HCV.
The clear message from the summit was to “Test and Treat” in all health settings.
Have you been tested?
Case Study: Providing treatment for Hepatitis C in an addiction service
By Dr Sarah Blair, Medical Officer Addiction Services at Capital & Coast District Health Board.
Overall about 76% of people receiving Opioid Substitution Treatment (OST) have the HCV antibody (O'Connor, P., Judson, G., Loan, R., & Robinson, G. (2016). Prevalence of hepatitis C among injecting drug users attending drug clinics. New Zealand Medical Journal, 44-48).
The cohort is ageing, with increased levels of co-existing physical and mental health issues, and the costs of care are estimated as being between NZ$166 and NZ$400 million. The impact of chronic, mild to moderate HCV symptoms upon wellbeing and employment contributes to the health inequity experienced by people with mental health and addiction issues.
Recently funded direct-acting antiviral (DAA) medications have cure rates of well over 90% and there is no evidence that this is any lower for people who inject drugs. However, people who inject drugs often find it difficult to engage in specialist medical care. Barriers include:
- lack of specialist staff
- fear of adverse consequences of seeking help
- multiple co-existing problems
- socioeconomic adversity
- continued substance use
- difficult access to veins.
Capital and Coast Addictions Service initiated direct-acting antiviral treatment for a group of people receiving OST as a trial, once this was funded by Pharmac in June 2016.
This began with clinicians at the service being trained to use DAAs and the development of formal relationships with Capital & Coast DHB Infectious Diseases Department and regional gastroenterology services. An information evening was then hosted in the community rather than within the addiction service to place the trial in consumer-ownership rather than service-ownership. The treatment process was explained, and this included the benefits of family and whānau inclusion, assessment of drug interactions and the need for contraception. Information sheets and invitations to treatment were distributed.
Twelve people were treated in the addiction service within the first year of DAA availability. A clinic was provided on an on-request basis and people were seen initially by a medical officer and a nurse or case manager. In most instances, the person was able to leave with a prescription. The average age of people who began DAA treatment was 43. All 12 achieved viral clearance, with no one experiencing severe or prolonged side effects.
You guys are the ones who know me and all my stuff
The provision of treatment within the Addiction Service for people receiving OST was highly appreciated. Feedback included “I don’t know my GP and my GP doesn’t know me,” and “You guys are the ones who know me and all my stuff”.
Providing treatment also improved engagement and was seen as a positive by staff and the relationship with people receiving OST often improved during treatment.
Since the trial, a further three people with higher levels of co-existing problems have had successful treatment. Two used substances chaotically and were not enrolled in primary care, and the third had severe psychosis.
In addition to the HCV clinic, the addiction service encouraged access to HCV treatment in primary care. The Primary Health Care liaison team provided targeted training, and education for GPs regarding assessment, treatment and follow up for people with HCV. As a result, several people prescribed OST via their GP successfully received treatment from their own GP.
Providing DAAs within an addiction service is effective, safe, and in keeping with the aims of Equally Well.