HepatitisWA Newsletter December 2017

Newsletter Issue 20 | December 2017

A WELCOME HAVEN IN WA for People with hepatitis C | P.6

CLOSE TO 3 MILLION PEOPLE access hepatitis C cure | P.14

DEC 2017

CONTENTS

12

15

PERSONAL PERSPECTIVE

COMMUNITY NEWS

PROMOTIONS

15 To whom it may concern

04 Message from HepatitisWA’s Management

05 Join us in the Social

Media World

A personal perspective by a happy anonymous female client

FEATURES 06 A Welcome Haven in WA for

people with hepatitis C 10 Ursula’s feedback from Alaska

and Brazil Conferences

Interview with HepatitisWA’s chair

Written by Frank Farmer

08 Going Viral

A round-up of articles on viral hepatitis.

23 Hepatitis B Program 2017

Insightful infographic of this years

program participants, partners and ambassadors

person Ursula Swan

12 Close to 3 million people

access hepatitis C cure

World Hepatitis Summit 2017 calls

for accelerated action to eliminate viral hepatitis

19 Coping with Christmas

Tips to thrive and survive the festive, yet stressful season

stay

2

Connect with HepatitisWA on Facebook and Twitter today.

14 Deen Clinic Services 22 Hepatitis Workforce Development

WASUA’S DOMAIN 20 Interview with WASUA’s Nurse

Practitioner, Leanne

Written by Gari-Emma Perry

HEALTH & LIFESTYLE 16 Keeping Active

Tips to kick start your fitness plan 18 Recipe: Green Detox Juice

Recipe by HepatitisWA

Hepatitis B team

connected www.hepatitiswa.com.au

www.facebook.com/HepWA

www.playthebloodrule.com

www.twitter.com/HepatitisWA

HepatitisWA Newsletter // December 2017

LETTER FROM

THE EDITOR

Hello, my name is Eliana, nice to meet you, I’m the new editor for the HepatitisWA newsletter. In this edition, we reflect on a year that has seen triumphs in viral hepatitis research and treatments within the state, nation and on the global stage.

Eradicating viral hepatitis by 2030, though a difficult task, is now a real possibility due to the new treatments available. After the World Hepatitis Summit in Sao Paulo, Brazil, countries around the world are creating strategies to meet this target. Research from the Summit highlighted that close to 3 million people globally have already accessed the hepatitis C cure (read more on page 12). HepatitisWA’s Chairperson Ursula Swan attended the summit and shares her experience on page 16.

As 2017 comes to a close we celebrate our Deen Clinic, whose doors have now been open for over a year. Thanks to the new hepatitis C treatments provided through the Pharmaceutical Benefits Scheme (PBS) our clients are receiving testing, treatment and support to be cured of hepatitis C. After our successful ‘Hepatitis C Cure Campaign’ in July our phones have been busy with enquires about accessing treatment. In turn, the Deen Clinic has now prescribed hepatitis C treatment to 77 patients. Our Personal Perspective this edition is a letter sent to our clinic from a happy anonymous female client. Read more about her experience on page 15.

HepatitisWA would like to wish all our clients, members, partners, and readers a very Merry Christmas and Happy New Year.

Eliana Ennis Editor

Newsletter Editor Eliana Ennis Graphic Artist Eliana Ennis Board of Management Executive Members Chairperson Ms Ursula Swan Vice Chairperson Ms Max Taylor Treasurer Mr David Wilding Secretary Ms Selena West Non Executive Members Dr Aesen Thambiran Ms Carol Houghton Patron Dr Charles Watson Executive Director Frank Farmer Postal Address PO Box 67 Francis Street Northbridge, WA 6865 Information & Support Line Monday - Friday 9am - 5pm (08) 9328 8538 Metro 1800 800 070 Country Office 134 Aberdeen Street Northbridge, WA 6003 Telephone: (08) 9227 9802 Fax: (08) 9227 6545 Web: www.hepatitiswa.com.au Proof Reading Frank Farmer Sally Rowell Email the Editor resources@hepatitiswa.com.au

Opinions published in the HepatitisWA Newsletter are not necessarily those of the editor or of HepatitisWA (Inc). Information in this newsletter is not intended to take the place of medical advice from your GP or specialist. You should always get appropriate medical advice on your particular needs or circumstances. *Disclaimer: The copyright of external articles published in this newsletter remain with the original authors and publishers, unless otherwise stated.

HepatitisWA (Inc).

HepatitisWA is a community based organisation which provides a range of services to the community in response to viral hepatitis, particularly hepatitis B and C. Please contact us for more information, or make an appointment to stop by and talk with an appropriate member of our staff.

MESSAGE FROM MANAGEMENT Progress on hepatitis C treatment uptake but challenges remain if elimination to be achieved by 2030 The number of Australians living with hepatitis C and advanced liver disease has fallen for the first time in ten years but elimination of the virus by 2030 remains a challenging goal.

Surveillance figures indicate that between March 2016 and February 2017 an estimated 42,800 people in Australia were cured of hepatitis C following treatment with new direct acting antiviral therapy.

Australian Government has signed up to the World Health Organisation’s target for virtual elimination of hepatitis C by 2030. To meet this target, Australia must sustain the initial surge in treatment through screening of high-risk populations, including people with current or past injecting drug use, prisoners and immigrants from high-prevalence countries.

The risk is that with the curative hepatitis C treatments available we think that the job is done, however that is far from the case. With an estimated 190,000 people yet to access treatments, Australia must not become complacent in relation to maximizing treatment access for people living with hepatitis C. It is imperative that we maintain the momentum of people taking advantage of the cure, which can transform lives.

Data from the Kirby Institute reveals that over the past five years hepatitis B diagnoses have declined by 27 per cent in people aged less than 25 years, largely due to infant and adolescent vaccination programs. Only 63 per cent of the estimated 230,000 people living with chronic hepatitis B in Australia have been diagnosed, and only a third are having their hepatitis B regularly monitored.

FRANK FARMER, EXECUTIVE DIRECTOR, HEPATITISWA 4

HepatitisWA Newsletter // December 2017

j o i n u s i n t h e s o c i a l m e d i a w o r l d. . . .

Keep up-to-date on: Latest news Events Resources & Publications Campaigns while connecting with our community

F i n d u s o n w w w. fa c e b o o k . c o m : H e pat i t i s WA

F i n d u s o n w w w.t w i t t e r .c o m : @ H e pat i t i s WA

A WELCOME HAVEN IN WA FOR PEOPLE WITH HEPATITIS C Reprinted from volume 14, edition 3 of Anex Bulletin, published by Penington Institute.

Article by Evan Young.

Too many people are experiencing stigma or discrimination because they are living with hepatitis C virus (HCV). Many don’t understand the virus or the threats it poses. People feel uncomfortable talking freely about it.

According to Hepatitis Australia, approximately 230,000 Australians live with chronic HCV. It is estimated that 15 per cent of those people have not yet been diagnosed. Left untreated, HCV can lead to liver cancer and liver failure. HCV testing and treatment is crucial to stopping the spread of the virus.

“The NSP is a perfect place to engage with a population who is the most affected by HCV,” says Hepatitis WA’s Steve Fragomeni. “In lots of ways NSP clientele are a captive audience. If you are genuine and inclusive, clients are usually happy to hear about ways to improve their health.

The NSP might be one of the only health services they access where they actually feel welcome.”

Steve says it is important NSP workers understand how years of negative stigma may influence the decision of a client whether to seek testing and treatment.

“Some patients are not in the right position, or are just not ready, to deal with the process of getting 6

onto treatments,” he says. “Some have lived with the virus for so many years it has become part of their identity. Most of their peers are the same, so it becomes a community. They have witnessed the old days of the harsher Interferon-based treatments and have consciously decided not to pursue newer treatments. They feel unfairly judged and will avoid health services because of this.”

Former drug user Sam*, 56, decided to finally undergo HCV treatment about four months ago. He was diagnosed over eight years ago, contracting the virus via needle sharing. “I went to the doctors and they gave me a blood test.

They told me I had hep C. I didn’t really care about (the virus) at that time because I was on drugs,” he says.

Sam says he knows lots of other people living with HCV – mostly other people who use drugs – who aren’t doing anything about it. “Some people think they’ll be judged if they look for medical help. Others, like me, they don’t care – they’re in a different world. I doubt they’d know what to do if even if they wanted to get tested and treated, anyway.”

Despite not seeking help immediately, Sam says it was an easy decision to do so once he learned more about HCV. “When the doctors told me it takes ten years off your life, I knew I wanted to take action,” he says. “I didn’t know it was so

HepatitisWA Newsletter // December 2017

Source: Reprinted from volume 14, edition 3 of Anex Bulletin, published by Penington Institute. Article by Evan Young.

FEATURE

serious. When they told me about that, the nurses and doctors were really good and supportive.”

It seems clear that there’s a need for more discussion: too many people living with HCV don’t appear to know the importance of the help available nor how to access it.

“Promoting testing and treatment in quick interventions with clients can be difficult. The only way I see for us to address this issue is for the wider health care community to continue to try and better educate people,” says Hedland Well Women’s Centre’s Rebekah Worthington.

“We try to make it clear we’re here

Rebekah says Sam isn’t alone in not knowing about the types of services patients with HCV can access. “The main barrier we see from clients is the lack of knowledge of service providers and what’s available to them,” she says. “While our centre offers a diverse range of services, it may not be clear to every client how testing and treatment can be accessed.”

Rebekah says the Hedland Well Women’s NSP works really hard to create a welcoming space for clients to ask for assistance if and when they may need it. She says she has no golden rules or set of conversational tips to share; NSP workers should simply strive to create the safest space possible. *name changed to protect privacy.

to assist clients in any way we can,” Rebekah says. “Those who feel most comfortable in coming forward with questions about treatment and help are the clients we’ve developed a relationship with over time.”

“Clients are often not up for much conversation when they come in for a visit. We think the best and most effective way to raise testing and treatment with clients is through fit pack promotional material and through building rapport with them.”

Call HepatitisWA Helpline (08) 9328 8538

HepatitisWA Newsletter // December 2017

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GOING VIRAL A R O U N D - U P O F A R T I C L E S O N V I R A L H E PAT I T I S

HIGH RATE OF HEPATITIS C REINFECTION IN GERMAN MEN WHO HAVE SEX WITH MEN

A

round one in seven gay and bisexual men cured of hepatitis C at major treatment centres in Germany have become reinfected since 2014, according to findings from the German Hepatitis C Cohort presented on Friday at the 16th European AIDS Conference (EACS 2017) in Milan.

At least half of these men became reinfected within a year of completing treatment and all reinfections occurred within 18 months.

The risk of reinfection is thought to be highest among men who share drug injecting equipment during sex – chemsex – but Dr Stefan Mauss of the Center for HIV and Hepatogastroenterology in Dusseldorf said that sharing drug injecting equipment during sex might explain only a quarter of these cases of reinfection.

People infected with hepatitis C who are cured of the infection are vulnerable to reinfection. Although a proportion of people will cure hepatitis C infection spontaneously, it is not clear if a successful response to previous treatment increases the likelihood of clearing hepatitis C virus (HCV).

Several studies with varying periods of follow-up have looked at the risk 8

of reinfection among men who have sex with men in Europe.

A study in London carried out prior to the introduction of directacting antiviral treatment found an incidence of reinfection of 9.6 cases per 100 person-years of follow-up.

More recently, a multicentre study in western and central Europe found an incidence of reinfection of 7.3 per 100 person-years. The study also found big variations between cities.

The German Hepatitis C Cohort collects information on everyone treated with direct-acting antivirals at nine treatment centres in Germany.

In this analysis, investigators reviewed reinfection rates among 1533 people who had been cured of hepatitis C and compared rates of reinfection according to potential risk factors.

Thirty-two cases of reinfection were identified, all in men. Five cases occurred in men who injected drugs (an incidence of 0.96%). Twentyseven cases occurred in men who have sex with men (an incidence of 13.1%). Only seven of the men who have sex with men said that they had used intravenous drugs, suggesting either a discomfort about disclosing drug use or predominantly sexual transmission.

Reinfection occurred fairly soon after completing treatment, in a median of 53 weeks (range 36-70 weeks).

In almost half of cases (44%) the reinfection was a new genotype.

A study of acute HCV infections at one of London’s largest sexual health and HIV clinics, the Mortimer

Market clinic, found that among 95 people diagnosed with acute HCV infection between 2015 and 2017, 27% reported condomless anal intercourse as their only risk factor.

Almost all those acutely infected with HCV were men who have sex with men (94%) and only 27% reported injecting drugs.

Almost a quarter of the infections (22 cases) occurred in people who were HIV negative, leading presenter Emily Chung to recommend that risk-based screening for HCV infection should now be considered for HIV-negative men who have sex with men.

AIDSMAP .

October 28, 2017 Keith Alcorn, www.aidsmap.com/page/3185713/

THE BENEFITS AND COSTS OF NEW HEPATITIS C TREATMENT IN AUSTRALIA

A

pproximately 230,000 Australians have been living with chronic hepatitis C, a virus transmitted through blood-to-blood contact. There is no vaccine to protect against hepatitis C but the infection can be treated, and now in most cases, cured. Unsafe injecting drug use continues to be the highest risk factor for contracting hepatitis C. It can also be contracted through unsafe tattooing and body piercing practices.

HepatitisWA Newsletter // December 2017

Disclaimer: The news articles displayed in the HepatitisWA Newsletter remain the copyright of the original authors and news publications.

COMMUNITY NEWS

New medicines available – what difference do these medicines make?

In March 2016 new direct-acting antiviral medicines were listed on the Pharmaceutical Benefits Scheme (PBS). Australians living with hepatitis C now have unprecedented access to curative therapies. For people living with hepatitis C, these new medicines provide a cure for a debilitating and potentially lifethreatening liver disease. They allow people to get on with their work and family life, and just do what they enjoy without the constant fear of an uncertain future. For some people, these ground-breaking new medicines are nothing short of lifesaving. The duration of treatments for most people ranges between 8 - 12 weeks.

Heralded as the dawn of a new treatment era, interferon-free therapies can cure hepatitis C in the major genotypes in Australia and have exceptionally high cure rates exceeding 95 per cent, shorter treatment durations and far fewer side-effects than previous therapies.

Experts believe these medicines hold the key to halting spiraling rates of serious liver disease and even eliminating hepatitis C as a public health concern in Australia within a generation.

General practitioners are able to prescribe new hepatitis C medicines.

This greater involvement of GPs in hepatitis C treatment signals a significant opportunity to scale up treatment in the community and make it easier for many people to

be treated by their local GP. The growing involvement of GPs in hepatitis C treatment will increase treatment capacity and make the treatment journey quicker and smoother for patients.

What is the cost of the hepatitis C medicines to people living with hepatitis C? Since the introduction of these medicines on the PBS the cost to people living with hepatitis C is $38.80 per script or $6.30 and free for eligible Aboriginal people through closing the Gap. What is the cost of these medicines to the Australian Government?

The Australian Government received expert advice that around 60,000 people were likely to be treated with the new hepatitis C medicines in the first five years. The Australian Government therefore used this figure as the basis of their negotiations with pharmaceutical companies and agreed to provide a capped amount of around $1 billion over 5 years for the expected 60,000 individual treatments.

A risk-sharing agreement was also negotiated with the pharmaceutical companies, which divided the $1 billion government funding over the five-year period. Under this agreement, if treatment costs exceed the agreed limit for any single year, prescriptions will continue to be dispensed, but any extra cost will substantially be met by the pharmaceutical companies themselves. It is this aspect of the agreement that provides certainty

to the Australian Government that the $1 billion investment will not be exceeded.

HEPATITIS AUSTRALIA .

Content reworked from information sheet March 8, 2017

Now is the time to act and take advantage of the new hepatitis C treatments available. Contact your GP today or call the HepatitisWA helpline on (08) 9328 8538 for further information.

HOW AFRICA IS BURDENED

BY VIRAL HEPATITIS

A

frica is home to ten of the 21 countries that together have 80 per cent of the global burden of hepatitis C involving people up to 19 years old, a conference has heard.

According to a study presented at the World Hepatitis Summit in Sao Paulo, Brazil (1-3 November), 325 million people lived with viral hepatitis in 2016, with 48 million children under 18 years old having hepatitis B and four million children under 19 years old living with hepatitis C. Advocacy and partnerships are needed to help combat viral hepatitis, say experts.

SCIDEV .

November 14, 2017 Sam Otieno, to read the full article go to; www.scidev.net/sub-saharanafrica/health/news/africa-burdened-viral-hepatise.html�

HepatitisWA Newsletter // December 2017

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Ursula’s feedback from Alaska and Brazil Conferences HepatitisWA’s Chairperson Ursula Swan attended two viral hepatitis conferences earlier this year, the World Indigenous People’s Conference in Alaska and the World Hepatitis Summit in Sao Paulo, Brazil. We asked her a series of questions to learn more about her contrasting experiences at both.

• Having 18 Aboriginal members from Australia (largest representation at the conference, thanks Minister Wyatt for some of the funds)

1. What were the highlights of each of the conferences that you attended?

2. What were the take home messages for each of the conferences?

Alaska: Visiting the Alaskan Native Hospital.

Alaska: eating fresh foods when undergoing

It is a 65 bed tertiary hospital that caters for all Native Alaskans and Native American Indians.

Ronald McDonald House had entered into an agreement with the hospital and has one floor of the building. The rooms are like a home and feel safe and comfortable. The artwork displayed on each level is amazing. All donated by the families that have had family members attend the hospital for treatment.

treatment for either Hepatitis B or C

• Meeting Grandma Rita, who is one of 13 Grandmothers from around the world that influence politicians and policy makers on what is best for their communities 10

HepatitisWA Newsletter // December 2017

Brazil: Hearing all the stories from around the globe as to what each country is doing to reach elimination of viral hepatitis.

• I was very interested in the Polaris Observatory that uses geo-spatial mapping to determine hot spots of hepatitis around the world. It has been developed and managed by the CDA Foundation a non-profit organisation. Their goal is to provide data, tools, training and decision analytics to support the elimination of hepatitis B and C globally by 2030.

Brazil: All agencies, be they government, nongovernment or not-for-profits need to work together to share ideas, what works, what barriers

FEATURE they have encountered to allow others to succeed in this major goal. Sometimes being creative with ideas when there is limited funding available.

3. In your opinion, how is Australia doing around viral hepatitis in comparison to other countries?

Australia is third in the world for being on target to eradicate and eliminate hepatitis by 2030. The first two countries are Qatar and Iceland. In saying this Australia does need to increase their screening to ensure we meet this target especially in our prisons.

Some countries have implemented a National Screening Policy whereby everyone must undergo screening. Unfortunately under our Public Health Policy this will not happen in Australia.

4. Was there any stand out speakers, presenters or events that really stood out for you?

Alaska: An Aboriginal man from lutruwita (Tasmania) shared his experience of being hepatitis C positive. It took him four years to overcome the shame factor to reach out and seek help. This has now happened and he is free of the virus. His final statement in his presentation was “hep C cannot define who I am!”

• A gentleman from Brazil told his story (through an interpreter) of how he contracted hepatitis B and C from traditional ceremonial activities.

Where he comes from all the warriors have lots of tribal tattoos and scarification. The Elders of the tribe decided that each warrior who undergoes their ceremonies will each have their own implement to stop the transmission. He is grateful that there has been no transmission to his wife and children.

• Leaving Anchorage on a plane and sitting next to a lady with an emotional support dog (who sat under the seat part). Me being me, had to

ask the question, why do you have a support dog? She had experienced an air plane crash, no physical problems but heaps of emotional ones and consequently diagnosed with PTSD. She had purchased the dog that was a cross between a poodle and a golden labrador and named him Benson. He had lots of training and was very well behaved on a six hour flight to San Francisco. I must say I had a very relaxing flight back, just patting him and rubbing his long ears, I thanked her for sharing her story.

Brazil: Dr. Mohammed Ali from Bangladesh who spoke about how he and his team go out to the people in the villages to educate, screen, provide treatment and do further health promotion so that the individuals can make better and informed choices. One of his stories was very sad. In one village there are one million refugees (who arrived only since August 25, 2017). There are 300,000 pregnant women in this community that is stuck on the hillside with no running water, limited food, no sanitation and no access to maternal services. That story touched my soul because I felt powerless to do anything.

5. Do you think that the WHO targets for hepatitis B and hepatitis C are realistic – particularly for Australia?

• The WHO targets are realistic as long as we have a concerted effort in screening more people, then those that are positive for hepatitis C getting them into treatment. And for those positive for hepatitis B ensuring they receive treatment or six monthly monitoring and getting family members vaccinated (if not already).

6. Did you come away from the conferences feeling inspired?

• The World Hepatitis Alliance conference in Brazil showcased what countries are doing globally which is exciting. All I want to do is screen everyone…

HepatitisWA Newsletter // December 2017

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Close to 3 million people access hepatitis C cure World Hepatitis Summit 2017 calls for accelerated action to eliminate viral hepatitis

This article is a press release issued by World Health Organisation, Geneva

Hosted by the Government of Brazil, the World Hepatitis Summit 2017 is being co-organized

by WHO and the World Hepatitis Alliance. The 31 OCTOBER 2017 | SÃO PAULO, BRAZIL Summit aims to encourage more countries to take On the eve of the World Hepatitis Summit in decisive action to tackle hepatitis, which still causes Brazil, WHO reports increasing global momentum more than 1.3 million deaths every year and affects in the response to viral hepatitis. A record 3 more than 325 million people. million people were able to obtain treatment for hepatitis C over the past two years, and 2.8 million “We cannot lose sight of the fact that last year more people embarked on lifelong treatment for 194 governments committed to eliminating viral hepatitis B in 2016. hepatitis by 2030. For sure we are still a long way from this goal but that doesn’t mean it’s some “We have seen a nearly 5-fold increase in the unattainable dream. It’s eminently achievable. It number of countries developing national plans just requires immediate action,” says Charles Gore, to eliminate life-threatening viral hepatitis over President of World Hepatitis Alliance. “The World the last 5 years,” says Dr Gottfried Hirnschall, Hepatitis Summit 2017 is all about how to turn Director of WHO’s Department of HIV and WHO’s global strategy into concrete actions and Global Hepatitis Programme. “These results bring inspire people to leave with a ‘can do’ attitude.” hope that the elimination of hepatitis can and will become a reality.”

“Brazil is honored to host the World Hepatitis 12

HepatitisWA Newsletter // December 2017

Source: This is a Press Release issued by WHO, Geneva

FEATURE Summit 2017 – and welcomes this extraordinary team of experts, researchers, managers and civil society representatives to discuss the global health problem posed by viral hepatitis,” says Dr Adele Schwartz Benzaken, Director of the Brazilian Ministry of Health’s Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and Viral Hepatitis.”Brazil is committed to taking recent advances in its response to hepatitis forward – on the road to elimination.”

Progress in treatment and cure Many countries are demonstrating strong political leadership, facilitating dramatic price reductions in hepatitis medicines, including through the use of generic medicines—which allow better access for more people within a short time.

In 2016, 1.76 million people were newly treated for hepatitis C , a significant increase on the 1.1 million people who were treated in 2015. The 2.8 million additional people starting lifelong treatment for hepatitis B in 2016 was a marked increase from the 1.7 million people starting it in 2015. But these milestones represent only initial steps – access to treatment must be increased globally if the 80% treatment target is to be reached by 2030.

However, funding remains a major constraint: most countries lack adequate financial resources to fund key hepatitis services.

Diagnosis challenge To achieve rapid scale-up of treatment, countries need urgently to increase uptake of testing and diagnosis for hepatitis B and C. As of 2015, an estimated 1 in 10 people living with hepatitis B, and 1 in 5 people living with hepatitis C, were aware of their infection. Countries need to improve policies, and programmes to increase awareness and subsequent diagnosis.

Prevention gaps Countries need to provide a full range of hepatitis prevention services that are accessible to different

population groups, particularly those at greater risk.

Largely due to increases in the uptake of hepatitis B vaccine, hepatitis B infection rates in children under 5 fell to 1.3% in 2015, from 4.7% in the pre-vaccine era.

However, the delivery of other prevention services, such as birth-dose vaccination for hepatitis B, harm reduction services for people who inject drugs, and infection control in many health services, remains low. This has led to continuing rates of new infections, including 1.75 million new hepatitis C cases every year.

Need for innovation Innovation in many aspects of the hepatitis response must continue. New tools required include a functional cure for hepatitis B infection and the development of more effective point-ofcare diagnostic tools for both hepatitis B and C. “We cannot meet the ambitious hepatitis elimination targets without innovation in prevention interventions and approaches, and implementing them to scale,” said Dr Ren Minghui Assistant Director-General for Communicable Diseases, WHO. “The great successes of hepatitis B vaccination programmes in many countries need to be replicated and sustained globally in the context of moving forward to universal health coverage.”

Implementation of elimination strategy The World Hepatitis Summit 2017 will be attended by over 900 delegates from more than 100 countries, including Ministers of Health, national programme managers, and representatives from organizations of people affected by viral hepatitis.

The Summit will review progress and renew commitments by global partners to achieve the elimination of viral hepatitis by 2030 – a target reflected in WHO’s elimination strategy and the UN Sustainable Development Goals.

HepatitisWA Newsletter // December 2017

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HepatitisWA’s Deen Clinic is open for hepatitis C treatments.

Available to people who continue to use drugs and/or who do not have a GP.

100%

Bulk-Billing

Make an appointment on (08) 9227 9800.

Our services include: Hepatitis C testing

134 Aberdeen St, Northbridge WA 6003

Hepatitis C treatment

P: (08) 9227 9800

Support Referrals 14

HepatitisWA Newsletter // December 2017

E: info@hepatitiswa.com.au W: www.hepatitiswa.com.au

PERSONAL PERSPECTIVE

TO WHOM IT MAY CONCERN, I am a 52 year old female.

I have had the hepatitis C virus since I was 18 years old and I have lived with the virus and the stigma that goes with it for 34 years.

I came across the HepatitisWA Deen Clinic in Northbridge and decided to try the new treatment. The staff there are the most amazing people I have come across in the medical field. That includes all of the the staff from reception to the Specialists. I was thrown back by all the lovely attention I received and whats more it was all free! The best clinic I have ever walked into. The treatment was successful and I did not get one side effect at all throughout the whole 12 weeks. I followed instructions properly all the way through. I received calls from the clinic to see how I was going and they assured me if I ever wanted someone to talk to they would always be there.

Thankyou to you all as this experience has been life changing for me.

Kindest regards,

A Happy Anonymous Female client HepatitisWA Newsletter // December 2017

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KEEPING ACTIVE HepatitisWA would like to thank beyondblue for providing permission to republish this article.

Regular physical activity is a good way to help prevent or manage mild anxiety and depression.

Keeping active can help you stay physically fit and mentally healthy.

Research shows that keeping active can: • help lift mood through improved fitness and the release of natural chemicals in the brain • help improve sleeping patterns • increase energy levels • help block negative thoughts and/or

distract people from daily worries • help people feel less alone if they exercise with others.

Physical activity increases your wellbeing. The current recommendation is at least 30 minutes of moderate intensity physical activity on most, and preferably all, days of the week.1 However, 16

people with anxiety or depression may find it difficult to get started or get motivated, or continue to exercise on a long-term basis.

Tips to get started 1. Start simple Increase your activity levels gradually to improve your self-confidence and build motivation for more energetic activities. Start with simple activities such as shopping, driving, gardening or small household tasks.

2. Do what is enjoyable People with anxiety and/or depression often lose interest and pleasure in doing things they once enjoyed. Plan activities with friends or family that are enjoyable, interesting, relaxing or satisfying – with time these activities will become enjoyable again.

HepatitisWA Newsletter // December 2017

Source: Republished from beyondblue website: www.beyondblue.org.au/get-support/staying-well/keeping-active

HEALTH & LIFESTYLE 3. Include other people People with anxiety and/or depression often withdraw from others, but continuing to socialise is an important part of recovery.

Staying connected with friends and family helps increase wellbeing, confidence and provides opportunities to socialise.

4. Make a plan Planning a routine can help people become more active – make sure some form of exercise is included each day. Try to stick to the plan as closely as possible, but be flexible.

Activity Plan Examples of activities to include in your routine Keep fit • Go for a walk or bike ride • Do some gardening • Go bush walking • Go swimming • Go to the gym Pamper yourself • Have a bubble bath • Buy some flowers • Lie on the beach and read a book • Get a massage Socialise • Invite a friend over • Visit a neighbour • Phone a friend for a chat • Take your children/pets to the playground/park Entertain yourself • Read a book or magazine • Write a letter/email • Play a solo card game • Do a crossword/Sudoku Around the house • Cook something new • Listen to music/the radio • Play in the backyard with your

children or pets • Do some gardening

Away from home • Visit a friend • Join a club or group • Go to a market • Visit a museum/art gallery/library • Go to a movie

Useful resources when developing an activity plan - General practitioners (GPs) can provide advice and information about anxiety, depression and exercise, and provide referrals to exercise physiologists.

- Exercise physiologists are qualified health professionals who provide advice about health, fitness and exercise. People with ongoing health conditions can access their services at subsidised rates through Medicare.

- Many councils offer free or subsidised sport and recreation facilities, such as swimming pools, walking circuits, tennis courts and skating ramps. Check with your local council to see what is available in your area.

- Gymnasiums and sports clubs often have a range of classes, such as aerobics and Pilates; equipment such as rowing and walking machines; and some may have swimming pools. Most gyms have instructors who can develop personal fitness plans and help keep you motivated.

- Community centres or neighbourhood houses host a variety of groups with affordable membership fees. These may include aerobics, yoga, tai chi, dancing and walking groups. You can find these groups through your local council.

1. Pate RR, Prat M, Blair SN et al. (1995) Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association, 273(5):402–7.

HepatitisWA Newsletter // December 2017

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HEALTH & LIFESTYLE

GREEN DETOX JUICE To make sure you stay healthy this summer season why not try this GREEN DETOX JUICE? The recipe has been trialled, designed and taste tested by our Hepatitis B team here at HepatitisWA. It will keep your liver happy and cool you down on a hot summer’s day!

Ingredients: 5 stalks of Kale or Spinach 3 Apples 1 Lemon 1 Cucumber Instructions: Run all ingredients through a juicer and add ice to cool it down.

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HepatitisWA Newsletter // December 2017

FEATURE

Coping with

Christmas Christmas for most people is seen as a fun time of the year filled with many celebrations and gatherings with friends and family. However, for many people it may also be a time filled with a sense of loss, loneliness and anxiety. For those of you who find this period difficult here are some suggestions on how to keep yourself safe: 1.

Don’t let other people’s expectations dominate how and what you are doing or feeling at this time of the year, this even applies to your family.

2.

The financial strain and pressure to purchase gifts for friends and family can add extra stress to the day. If you are attending a gathering and do not want to arrive empty handed how about bringing a box of Christmas crackers or chocolates to share! These items are easily purchased at your local supermarket and are cost effective.

3.

For many however, Christmas is a lonely time. To avoid feeling isolated on the day make a plan to attend a community event whether it be a local church, carol service or the Mission Australia’s ‘Christmas Lunch in the Park’.

4.

Try not to drink in excess if you are in stressful situations – whilst you may wish to numb your pain with alcohol this could only exacerbate your feelings of anxiety and potential anger.

5.

Plan something for yourself on the day – whether it is going for a walk, spending time reading a book, playing with a pet or simply watching your favourite TV show. It is important that you feel that you are having some time for you.

6.

Don’t give yourself a hard time if you are feeling sad or depressed. It is ok to ask for support if you need it. Struggling to cope? Ask someone you feel safe talking to for their support.

If you don’t feel that you have anyone then there are the crisis care lines where you can talk to someone. Call Lifeline today 13 11 14 HepatitisWA Newsletter // December 2017

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WASUA’S DOMAIN

INTERVIEW WITH WASUA’S NURSE PRACTITIONER, LEANNE Leanne has been working as WASUA’s Nurse since December 2015. Leanne is an endorsed Nurse Practitioner with nearly two decades of specialised experience in viral hepatitis and advanced liver disease. She is a proactive team leader and problem solver with extensive experience working with public hospitals and other agencies. WASUA is privileged to have such an experienced Nurse Practitioner running our health clinic 3 days a week.

The clinic offers a range of services and helps to reduce the barriers faced by consumers when accessing health services by providing flexibility and better access for the patient. In the end, we are hoping that treatment will provide a point of connectedness between the consumers and the service, to engage consumers with other health services where appropriate, and to reduce felt and enacted stigma and discrimination.

2. How do you engage with IV drug Interview conducted and article written by users?

Gari-Emma Perry

1. Can you explain how WASUA’s peer based community hepatitis C treatment model works?

The WASUA peer based community treatment model offers consumers a simpler and easier way to access information and services. Initially, peer based information is provided to consumers; consumers are then referred to the clinic where pre-treatment assessment, on-going treatment management, and post treatment follow up is conducted at one place. During this process, consumers engage with WASUA’s peer worker who is able to make the process of engagement easier. This peer-facilitated case-management is an essential component of WASUA’s treatment model.

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HepatitisWA Newsletter // December 2017

It is very important to provide a service that is a one-stop-shop, where people can access a range of services at the same time. In this instance, many patients are referred to the health clinic after they have accessed needles and syringes.

We have streamlined the hepatitis C treatment program; this means that people can have their bloods taken here and pick up their medications at the same time. Treatment can be initiated in-house, the patient is not required to attend a pharmacy to pick up their medication, and there is no cost to those patients who have concession cards.

It is also really important to be aware of the stigma and discrimination surrounding injecting drug use. As health professionals we need to remember that people who inject drugs have

WASUA’S DOMAIN often had negative experiences with healthcare providers, therefore they are often fearful or reluctant to engage with health services. Another thing to remember is that not every health issue will link back to the person’s drug use.

3. Could you explain the importance of the peer worker role?

WASUA’s peer worker roles are vitally important for all clients attending WASUA. Peer workers at the Needle & Syringe Exchange Program (NSEP) desk have all been educated about hepatitis C and provide current information to clients. So, the NSEP is pivotal in recruiting patients for the health clinic and also in providing information to consumers. Co-locating the clinic in the NSEP building makes accessing treatment as easy as possible.

We have a number of peer workers who have completed the new treatments. Consumers who are considering treatment can have a chat with these workers regarding their experience.

We also have a case management outreach worker who works very closely with patients and provides follow up in the terms of phone calls and visits, and if required will assist the patient

in attending the clinic and attending blood tests or other medical appointments.

Trust is also a big issue for injecting drug users.

When any consumer walks through our door they are greeted by someone who understands them, who doesn’t judge them, and accepts them as they are.

4. In relation to hepatitis C treatment, What works well at WASUA? I think there are a few factors that contribute to why patients engage with certain services. I think it is important for a service to be responsive to the patient needs and as the patients’ needs change, the service must adapt accordingly.

Having peer workers work alongside or work with the consumers is essential. WASUA offers a multitude of other services which engage with consumers before they access the health clinic, and this is an integral component of the community peer based service model. WASUA’s peer and outreach workers are doing the work of engaging effectively with consumers, and it is this established and ongoing relationship that is essential in forming trust.

PERTH

SOUTH WEST

Van Phone 0418 739 372 Office (08) 9791 6699

(08) 9325 8387 www.wasua.com.au Perth NSEP Mon - Weds: 10am-5pm Thurs - Fri: 10am-8pm Sat & Sun: 11am-4pm Clinic Hours Tues: 10:30am - 1pm & 2pm- 4:30pm Wed: 12pm - 4pm Thurs: 10:30am - 1pm & 2pm- 4:30pm Closed Public Holidays WASUA provides a number of services on premises at 22/7 Aberdeen St, Perth WA 6000, including: • • • • • • • • •

NSEP (Needle and Syringe Exchange Program) Free hep A and B vaccinations for hepatitis C positive people Free blood testing in a friendly confidential environment Drug treatment support and referral Peer education and training Street-based outreach Advocacy and support for users Safe injecting and safe disposal education and resources Hepatitis C/blood borne virus information and resources

97 Spencer St, Bunbury (entry via Rose st) Opening Hours: Monday to Friday 10am - 3pm.

South West Mobile provides a mobile Needle Syringe Exchange Program (NSEP) God knows I never meant to hurtat the following you, hurt you hurtlocations you, hurtand you,times:

Margaret River Busselton Harvey Collie Manjimup

hurt you, hurt you Can we start over

Tues: 3pm-4pm Hospital Carpark again Can we start baby as friends Tues: 5pm-7pm Carpark Give you one more Hospital try The tender Weds:kisses 1pm-2pm Hospital Carpark you give to me Would be the Weds:only 3pm-4pm Hospital Carpark thing I’d ever need God knows Thurs:I12pm-1pm Hospital Carpark never meant to hurt you I never meant to break your heart, your babe. on exchangeable items * FREEheart equipment

* FREE resources and helpful information A confidential outreach service is also available throughout the southwest from Monday to Friday, for people who cannot attend the site locations.

Phone 0418 739 372 to arrange a suitable time.

HepatitisWA Newsletter // December 2017

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HepatitisWA Newsletter // December 2017

Hepatitis B program 2017 This project works mainly with people coming to Australia from countries with a high prevalence of hepatitis B with many of those countries not having vaccination programs.

We thought it might be interesting for our readers to get a bit of an insight into the numbers of people being reached by our Hepatitis B team which includes our Ambassadors.

Our Ambassadors are people from the targeted communities who are trained as presenters and then provide education and information sessions to their communities.

Education January- October 2017 Sessions 63 Education Liver Healthy Life 17 workshops 1181 people reached of people intend 95% to get tested

Health Ambassador reach

hep B partnerships

42% female

38% male

59%

Asian

24%

Sub-Saharan African

16%

1%

Other

Middle Eastern

52 asian 37 Middle east 48 Sub-saharan african 10 other

testing clinic

82% 18%

8 clinics 147 tested

82% female 18% male

54% vaccine offered 6% positive diagnosis 32% natural immunity 8% vaccine immunity HepatitisWA Newsletter // December 2017

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“THE CLINIC IS SO IMPORTANT AND MUCH EASIER WHEN YOU COME HERE TO US� FILIPINO WOMAN

Happy

Holidays!

Season’s Greetings from all of us at Our office will be closed

FROM THE 22ND DECMBER - 2ND JANUARY