Newsletter Issue 17 | December 2016
Australia leads the world in hep C treatments p.12
PERSONAL PERSPECTIVE | GOING VIRAL | HEALTH & LIFESTYLE
DECEMBER 2016
Contents
06
12
PERSONAL PERSPECTIVE
COMMUNITY NEWS
PROMOTIONS
06 Janie’s Story
04 Message from HepatitisWA’s Management
11 HepatitisWA Services
A personal perspective by Perth resident Janie Coppen.
hepatitis.
10 Royal Perth Hospital treatment defuses hepatitis time bomb 72 year old Charles Reid successfully completes his hep C treatment with the help of Royal Perth Hospital.
12 Australia leads the world in hepatitis C treatments New research has shown that
more people are on track to be cured of hepatitis C in Australia this year than over the past two decades combined.
14 Ambitious plan to ‘eradicate’ Hepatitis C Written by Jonathon Daly at
25 Deen Clinic Services
08 Going Viral A round-up of articles on viral
Features
Written by Frank Farmer.
WASUA’S DOMAIN 26 Do’s and don’ts of injection infection Written by Susan Carruthers
HEALTH & LIFESTYLE
(Hep C Community Development)
20 Hepatitis C & Food: An Introduction to Healthy Eating A summary of foods and how it
affects you if you have hepatitis C.
24 Recipe: Mexican Street Corn Salad Recipe from Live Eat Learn,
available at www.liveeatlearn.com
The Western Independent.
18 Hepatitis B: Is a cure possible? www.hepb.org
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HepatitisWA Newsletter // December 2016
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LETTER FROM
tHe eDItoR
Where has the year gone? This year has shown some remarkable and positive developments for Australians towards the development and the listing of new hepatitis C treatments through the Pharmaceutical Benefits Scheme (PBS) in March. This in turn has changed the landscape of hepatitis C in Australia. As mentioned in our feature article, Australia leads the world in getting more people on treatment of hepatitis C this year, than over the past two decades combined. More and more GPs and pharmacies are also getting on board with prescribing and offering the treatments throughout Western Australia. In this issue, we feature some articles on both hepatitis B and C, including a personal perspective by Perth resident and HepatitisWA volunteer – Janie Coppen, and an article featuring HepatitisWA, written by journalist Jonathon Daly for Curtin University’s Western Independent publication. Check it out on page 14! Other features include an article on Royal Perth’s successful treatment for 72 year old Charles Reid, and an article discussing the possibility of a cure of hepatitis B by UK’s publication HepB.org. In our “Health & Lifesyle” section, we publish an article on hepatitis C and healthy eating and a healthy and delicious Mexican Street Corn recipe. Lastly, HepatitisWA would like to take this opportunity to wish all our clients, fellow organisations and general readers a happy and safe holiday season, wishing you all the best for 2017!
Felicia Bradley
stay
connected
Editor
www.hepatitiswa.com.au
Newsletter Editor Felicia Bradley Graphic Artist Felicia Bradley Board of Management Executive Members Chairperson Ms Ursula Swan Vice Chairperson Dr Aesen Thambiran Treasurer Mr David Wilding Secretary Ms Carol Houghton Non Executive Members Mr Adrian Gallo Ms Max Taylor Ms Selena West 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
www.playthebloodrule.com www.facebook.com/HepWA www.twitter.com/HepatitisWA 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 A, 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.
HepatitisWA Newsletter // December 2016
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MESSAGE FROM ’s MANAGEMENT
Viral Hepatitis 10th Australasian Conference – Gold Coast 2016 The 10th Australasian Viral Hepatitis Conference was held at Surfers Paradise from Wednesday the 28th of September to Saturday the 1st of October. The first day of the conference was a satellite entitled ‘Hepatitis C Effective Treatment for Everyone’, which in reality is what the entire conference was about. There were many accolades for what Australia has achieved in securing universal access to the new hepatitis C treatments, which no other country has achieved. In most other countries there are either priority populations who can access treatments or some people excluded. Conference delegates were reminded that ‘the World is watching Australia’ to see what we can achieve with this extraordinary opportunity. As usual the conference had a clinical stream and community/social research stream. I stayed mainly with the community streams. From my perspective, the conference was all about ‘not leaving people behind’. This was the theme throughout the conference with people coming at this theme from slightly different angles. Given what HepatitisWA is aiming to achieve with our hepatitis C treatment clinic which is primarily for people who are currently using drugs, and those who do not have access to a GP, I felt we are pretty much at the leading edge of what the conference was about. It is estimated that Australia has treated over 26,000 people since March 2016, which is a phenomenal effort and has exceeded expectations. Under the old treatment regime we were treating less than 3000 annually. Professor Greg Dore estimates that we may well treat approximately 40,000 people in the first twelve months of the new treatments availability. It is expected that once the first wave of early responders have been treated there will be a slowdown in demand, and so one of the challenges is to ensure that the remaining majority of people living with hepatitis C are encouraged to access treatment, and importantly that some groups are not left behind. These include: • People who inject drugs • People with mental health issues • People in prisons and • People from multicultural communities To ensure that doesn’t happen there will be a need to reorient services to the community, that is take treatments to where people are at, tailor services to the particular needs of targeted groups and provide flexible, holistic services as required. Additionally, we were advised that we need to learn more about the people we need to reach, think and act beyond our usual networks, share positive stories and work together. Needless to say GPs and community services will need to continue to be encouraged to take an interest in hepatitis C. While it was pointed out that Western Australia is lagging behind in the uptake of the new treatments, it was reinforced that some states had well established nurse lead models already operating in tertiary and community settings (e.g. South Australia), which has made it easier for those states to adapt their services to accommodate the new treatments. Additionally, nurses were seen as pivotal in being able to identify patients who are not in the first wave, and 4
HepatitisWA Newsletter // December 2016
who might be left behind. It was suggested that education and training to more nurses would be one strategy to enhance treatment availability. AVILs presentation talked about the barriers to people who inject drugs in accessing treatments, mainly around stigma and discrimination, which we are well aware of. AVIL reinforced the value of peer based organisations and peer workers, which was also a recurring theme through the conference. There were a number of presentations on Aboriginal communities (e.g.: “Deadly Liver Mob’: Ms. Kerri-Anne Smith from the Mt. Druitt Community Health Centre; ‘Experiences of Diagnosis, Care and Treatment Amongst Aboriginal People’: Ms. Loren Brener). One which was entitled ‘Deadly Grandmothers’ by Jody Walton from Hepatitis Queensland was particularly impressive, which she summarizes here. DEADLY GRANDMOTHERS: PROPER WAY PARTNERSHIPS, SUPPORTING ELDERS WORKING WITH YOUNG PEOPLE IN COMMUNITY: Deadly Grandmothers began with Aboriginal grandmothers of the Scenic Rim Region approaching Hepatitis Queensland about a lack of support for Elders in the community. The grandmothers voiced concerns that, when dealing with hepatitis, drug use, and mental health issues among young Indigenous people, many programs focused on youth, while it was Elders (specifically grandmothers) who usually were responsible for social and health concerns in the homes. Elders also raised their concerns that, by educating only youth or youth workers, appropriate internal lines of authority and community structures were being ignored. Hepatitis Queensland obtained a grant to provide support and education to Elders of the Scenic Rim: To train Aboriginal and Torres Strait Islander Elders around hepatitis, drug use, mental health, and how to utilise support systems better-support young people at risk of, or affected by, viral hepatitis. Methods: Consultations and focus groups were conducted with the Grandmothers. These consultations significantly changed the direction of the planned education. Results: Mainstream design and planning of a conference were unsuitable. In order to build appropriate cultural process, new relationships were formed, utilising the Grandmother knowledge as a driver. The Grandmothers designed their own conference that encompassed strengthening cultural, parenting, and family connections. Conclusion: The Deadly Grandmothers project found that, for appropriate outcomes in Indigenous community, it is crucial that holistic non-Western models of communication, planning, relationships, and process, need to be included at all stages of the project. This presentation covers learnings about cultural protocols and processes for mainstream services working within Indigenous communities, and the importance of re-thinking what may be considered ‘normal’ process. Mainstream services cannot simply provide education, but must be self-reflective and form real relationships involving trust, time, and flexible process. There were a couple of presentations on prisons, one on the ‘Prison Economy of Needles and Syringes’ which informed us that prisoners pay between $50 and $350 for a syringe, and the various ways payment is achieved, and the importance of maintaining good relationships with prison staff (so people can go about their business with the minimum of interruption). Another presentation entitled ‘Relationships Matter: Social Capital Theory and the Delivery of Hepatitis C Treatment in Prison’ concentrated on the importance of relationships in a prison setting, between prisoners; prisoners and clinic staff and between prisoners and security staff. These inter-relations ships are all important in supporting people through treatment in a prison setting. In all it was a good conference, there was a lot of optimism and good will and a real willingness to succeed in maximizing the opportunity of elimination.
by Frank Farmer
HepatitisWA Newsletter // December 2016
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Photography by Felicia Bradley taken2016 with permission by Janie Coppen. Copyright Š 2016. 6 HepatitisWA Newsletter // December
PERSONAL PERSPECTIVE
JANIE’S STORY
A PERSONAL PERSPECTIVE
M
y husband and I were diagnosed with hepatitis C in the early 90’s. Back then people didn’t know much about the disease, all we knew was it killed you quickly or slowly and was highly infectious. We had two children and were told to be very careful with personal hygiene. We took this seriously, in fact I can say from that day on I was so terrified for their safety that I withdrew from close contact like cuddling and smooching my babies. Everything was separate from the children. We had no education about the disease, just diagnosis, “don‘t infect anyone else and look after yourself”. Many years later my husbands health was fragile, his liver count was at 2000 but still we were not given options. I changed our diet to unprocessed foods with a liver detox and got great results but it didn’t last. In May of 2010 he became very ill and after much protesting he agreed to go to hospital. He was admitted immediately and passed away one week later. His specialist was a lovely man who queried my health during that week and told me of a treatment for hep C. He explained that it was going to be a tough six to twelve months
treatment and it would eliminate the virus or make it dormant. In my grief and with my children’s help, I agreed.
“It was hard, but in hindsight, I’d do it again because of the wonderful knowledge that my hepatitis is no longer with me. My health is great and my life is on track.“ I began the Interferon treatment and it was hard, but in hindsight, I’d do it again because of the wonderful knowledge that my hepatitis is no longer with me. My health is great and my life is on track. Even greater is the new treatment that is available to anyone, with much less impact on your health. After the treatment I was sent to HepatitisWA for an A/B immunisation and met the great staff of the organisation. I learnt more in that visit than all the years since diagnosis. It was fantastic! I now volunteer for them and enjoy every minute. Sadly, my dear husband was unable to get the care he needed but I know he would be happy for me and my family to finally be free.
7 BY JANIE COPPEN
HepatitisWA Newsletter // December 2016
Going VIRAL A round-up of articles on viral hepatitis
AbbVIE’S HEPATITIS C
WA PUSH TO CRACK DOWN ON HEP C AND HIV
TREATMENTS SHOWS PROMISE
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rugmaker AbbVie Inc said on Friday its experimental fixed-dose combination to treat certain hepatitis C virus patients achieved high sustained viral response (SVR) rates after eight weeks of treatment.
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The once-daily fixed-dose combination, glecaprevir/ pibrentasvir (G/P), was given to HCV patients without cirrhosis and who were new to treatment in three different studies.
epatitis C notifications in Aboriginal people in WA are 22 times higher than in the rest of the population, WA’s Depart of Health has warned.
About 97.5 percent of these patients achieved a high SVR rate, which is the most widely used efficacy endpoint in clinical studies of hepatitis C, representing removal of HCV from the body.
The department has launched a campaign to encourage people to look after their blood and not to share needles.
There were no adverse events during the eight-week regimen and patients across all major genotypes of chronic hepatitis C achieved high SVR rates. “We’re on track to submit our next generation, pan-genotypic regimen to regulatory authorities by the end of this year in the U.S. and early 2017 in the European Union and Japan,” the company said. About 130 million – 150 million people live with chronic HCV worldwide. The World Health Organization estimates about 700,000 people die each year from liver diseases related to hep C.
BY FOX NEWS.. Nov 11, 2016 Fox News. tinyurl.com/abbvie-shows-promise
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It hopes to reduce the rates of HIV and hepatitis C. Communicable Disease Control director Dr Paul Armstrong said people with blood-borne viruses often looked and felt healthy, but it was important they got tested. “New diagnoses of hepatitis C have been gradually increasing in the Aboriginal population across Australia over the past five years, most commonly in 20 to 49 year olds,” he said. “In Western Australia, hepatitis C notifications in Aboriginal people reached a 10-year high in 2014, with the rate being 22 times higher than in non-Aboriginal people. “The proportion of newlydiagnosed HIV infections in Australia attributed to injecting drug use was also much higher in Aboriginal people than
non-Aboriginal people – 16% compared to 3%, respectively. “It is vital to increase awareness among Aboriginal people that by sharing injecting equipment, such as needles, they can make themselves sick and this can impact on their communities.” Dr Armstrong said a range of new treatments made it possible for people with blood borne viruses to continue to live long and healthy lives. Treatments with few side effects are now available through the Pharmaceutical Benefits Scheme and provide a cure for 95 per cent of people with chronic hepatitis C, he said. Effective treatments are also available for people living with HIV.
BY NIT.COM.AU. Sept 20, 2016 NIT.COM.AU. tinyurl.com/wa-push-crack-hep-c-hiv
Hepatitis C Treatment
Prognosis Continues TO AMAZE
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AS VEGAS — Rapid advances in the treatment of hepatitis C have clinicians seeing
HepatitisWA Newsletter // December 2016 Disclaimer: The news articles and excerpts displayed in the HepatitisWA Newsletter remain the copyright of the original authors and news publications.
COMMUNITY NEWS
outcomes they never thought possible, and experts are optimistic that more complex and challenging patients will respond to therapy. However, treatment choice can be tricky. And caveats are emerging, including reports that direct-acting antivirals used for the treatment of hepatitis C might increase the risk for hepatitis B reactivation and liver cancer in some patients. But the big picture is one of clinical success. “We know that 95% to 100% of patients treated for hepatitis C can be cured. It’s pretty amazing,” said Tram Tran, MD, from the Cedars–Sinai Medical Center and the University of California at Los Angeles. Dr Tran is one of several experts who provided an update on treatment regimens, genotypes, and evidence at the recent American College of Gastroenterology 2016 Annual Scientific Meeting. “Unlike most viruses, this is a virus we can cure,” said Stanley Cohen, MD, from University Hospitals Cleveland Medical Center, whose presentation looked at the latest options for the treatment of genotype 1. “The key is to keep screening, especially the baby-boomer generation,” Dr Cohen explained. Baby boomers should have at least one hepatitis C test, he said, citing an emergency department study that showed high rates of unrecognized disease in patients born from 1946 to 1965, as reported by Medscape Medical News.
Expanding Therapeutic Options For patients with genotype 1 hepatitis C, which is the most common form in the United States, cure rates are high with recommended treatment combinations, Dr Tran said. The
sustained virologic response cure rate in this cohort of patients is greater than 90%, “so I think for genotype 1, we have it in the bag,” she said. The goals of therapy include a sustained virologic response 12 weeks after the end of treatment (SVR12), although some clinicians monitor patients out to 24 weeks.
BY MEDSCAPE.. Nov 22, 2016 Medscape tinyurl.com/medscape-hep-c-news
‘ANTI-SCIENTIFIC’: HIV SUMMIT CONDEMNS SPITTING LAWS
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elegates at the Australasian HIV and AIDS conference have condemned the South Australian, Northern Territory and Western Australian government for continuing to uphold antiquated laws which force people accused of spitting at police to undergo compulsory HIV testing.
The laws originally came in force in 2015 (WA & SA) and in the NT in 2016 and were said to be for the protection of police officers; but many people now believe they are stigmatizing to people living with HIV. Delegates believe the laws continue to support an outdated and antiquated view of transmission of the HIV virus and promote unnecessary fear. Delegates voted unanimously on a resolution expressing their ‘profound disappointment’ at the passing of the laws. “Australia has a proud record of basing its HIV response on evidence-based policy,” said Associate-Adjunct Professor Levinia Crooks, CEO of the Australasian Society for HIV,
Viral Hepatitis and Sexual Health Medicine (ASHM) who is hosting the conference. “These laws are anti-scientific. The risk of transmission of HIV or other blood-borne viruses from saliva is practically zero. There is no justification for invading the privacy of people in custody by forcing them to undergo blood tests when there is no risk to the officer.” While Crooks acknowledged police and emergency service workers face risk in their every day duties, contracting HIV from saliva was not one of them. “There has never been a case of HIV transmission from spitting or biting in Australia,” Crooks said.
The full resolution as voted on by the delegates: As researchers, clinicians, and civil society representatives, we are united in our commitment to an HIV response grounded in evidence and protective of the human rights of people living with and affected by HIV. This conference expresses its profound disappointment in the governments of South Australia, Western Australia and the Northern Territory for enacting anti scientific and counterproductive laws mandating HIV testing for people accused of spitting on law enforcement personnel, in the face of overwhelming evidence that such laws are neither effective nor necessary. HIV is not transmitted in saliva and these laws only serve to further marginalise and criminalise people with HIV. We call on all governments to establish evidence-based protocols that protect the wellbeing of police and emergency workers and the rights of people living with HIV.
BY CEC BUSBY.. Nov 21, 2016 Gay News Network. tinyurl.com/spitting-laws HepatitisWA Newsletter // December 2016
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FEATURE
ROYAL PERTH HOSPITAL
TREATMENT DEFUSES HEPATITIS TIME BOMB
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hen Charles Reid’s brother Jim returned from the Vietnam War in 1969, he brought home more than physical and emotional scars from being peppered with machine gun bullets. A lifesaving blood transfusion he received for his wounds in Vietnam was infected with hepatitis C — a fact no one realised for 30 years. The disease ultimately took Jim’s life, but he also unknowingly infected his brother. “It was a ticking time bomb,” said Charles, 72, who lost his brother in February 2015. “Hep C is a terrible disease and it’s awful that it ended up taking my brother. When the doctor told me I had it, I didn’t want to accept it.”. Doctors confirmed both brothers had the disease in 2000 after they had ignored worsening symptoms, including chronic fatigue, for 10 years. Charles had probably contracted the disease from his brother while they worked as building subcontractors and often received cuts or abrasions. “I thought there’s no way I could have hep C because, like most people, you assume that hep C is only contracted through illegal drug use, but that’s not the case,” Charles said. Charles sought treatment, but Jim refused. The medication has only a 10
Saroj Nazareth and Charles Reid. Photo: Justin Benson-Cooper. 60 per cent success rate and major negative side effects, include erratic mood swings. Despite initial success, the disease returned within three months. The despondent father-of-four gave up on treatment and ignored his health for 15 years until his GP finally convinced him to act last year. But by then, the untreated hep C — exacerbated by Lynch disease, which made him more prone to cancer — had taken its toll. Charles had extensive cirrhosis of the liver and liver and bowel cancer. Doctors quickly removed both cancers and turned to revolutionary hep C drug therapy with a 90 per cent success rate. In February, Charles began taking the direct-acting antiviral drugs, accessible through the Pharmaceutical Benefits Scheme. Four weeks later, he was negative for hep C, which has not returned. Charles said he owed his life to Royal Perth Hospital specialists, including hepatology nurse Saroj Nazareth, who this week will be named Australia’s nurse practitioner of the year. “The sad reality is that for people who may have undergone treatment for hep C that failed, they haven’t ever bothered to come back, which is a mistake because this new treatment is amazing,” he said. “I was starting to think I wasn’t going to get a chance to spend more time with my boys and get to know my grandchildren. (But) thanks to everything they’ve done here at RPH, I’m going to be hanging around a bit longer”.
HepatitisWA Newsletter // December 2016 of the original authors and news publications at Perth Now. Article by Regina Titelius. Photo by Justin Benson-Cooper. Note: This news article remains the copyright Source: Perth Now – WA News. Available at http://tinyurl.com/RPH-treatment-success (17 November 2016).
HepatitisWA Newsletter // December 2016
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FEATURE
“There’s absolutely no doubt that Australia is the envy of the world.”
AUSTRALIA
LEADING WORLD IN HEP C TREATMENT
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BUT VIRUS MORE PREVALENT IN ABORIGINAL PEOPLE ore people are on track to be cured of hepatitis C in Australia this year than over the past two decades combined, new research has shown.
A University of New South Wales Kirby Institute report shows about 230,000 people were living with hepatitis C across the country last year, but only one in five received treatment. Hepatitis C is transferred by blood-to-blood contact and is often spread by sharing drug injecting equipment. An oral anti-viral treatment, with a cure rate over 90 per cent, was listed on the Pharmaceutical Benefits Scheme (PBS) in March, and more than 26,000 people have accessed help since. Professor Gregory Dore said the report results put Australia far ahead of other nations. “There’s absolutely no doubt that Australia is the envy of the world,” he said. 12
HepatitisWA Newsletter // December 2016 Disclaimer: This news article remains the copyright of the original authors and news publications at ABC News. Image licenced via Photodune. © All Rights Reserved Harvepino.
“In the first five months of access... more than 10 per cent of the population with chronic hepatitis C has already commenced these therapies.”
Professor Carla Treloar said it showed tailored solutions were necessary.
“If you compare that to many other countries in their first 12 months of treatment, if you can treat 5 or 7 per cent of the population in the first year of these therapies you’re thought to be doing pretty well.”.
“There are numerous ways in which the Aboriginal community could be targeted more specifically and in ways that are culturally appropriate to provide information, education and then links to care and support for people living with hepatitis C,” she said.
VIRUS ON THE COMMUNITIES
ABORIGINAL
“We know that prevention is cost effective and cheaper than cure.”
For Aboriginal and Torres Strait Islanders with hepatitis C, diagnoses have increased by over 40 per cent in the past five years.
“So we cannot lose sight of providing the technologies we know will assist people who inject drugs to protect and promote their health.”
Gadigal man Glenn Wagner said hepatitis C treatment was not always so simple, having suffered the debilitating side-effects of early treatments.
Professor Treloar said increased investment in syringe programs and opiate substitution treatments were needed.”
RISE
IN
“I lost 35 kilos, I had no appetite, everything tasted like cardboard,” he said. “Half the time I could sleep, half the time I couldn’t sleep.” “Once I had the injection, the next two or three days, I couldn’t do anything.” Since taking the new oral tablets, Mr Wagner has not experienced any side-effects. But the wider Indigenous population with hepatitis C is not showing such positive results, with the rate of diagnosis between three and four times greater than in nonIndigenous communities. “There’s no doubt that hepatitis C, and hepatitis B for that matter, have a disproportionate impact on the Indigenous population in Australia,” Professor Dore said. ACCESS AND AWARENESS OF TREATMENTS PROBLEM FOR MARGINALISED A second study from the UNSW Centre for Social Research and Health showed access and awareness of treatment among other marginalised groups continues to be a problem. It found of the 405 gay and bisexual men surveyed, only about a third were aware a treatment to cure hepatitis C was available.
HEP C STIGMA RAMPANT IN INDIGENOUS COMMUNITIES Mr Wagner said increased cultural understanding of Indigenous populations could help decrease hepatitis across communities. “There’s a lot of intergenerational mistrust of white Australia, so I think that plays into it,” he said. “Community is everything... because the stigma attached to hepatitis C is still prevalent and out there.” “If the community supports you, you don’t feel the shame.” Professor Treloar found those with hepatitis C, but with close ties to their Aboriginal community, were more likely to show greater resilience, have a better quality of life and experience less stigma, than those who were not as attached to their community. At 50 years of age, Mr Wagner is studying Human Services at university and is due to graduate next year. He was cured of hepatitis C last week. BY ABC NEWS.. Sept 29, 2016 ABC News tinyurl.com/oz-in-the-lead HepatitisWA Newsletter // December 2016
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FEATURE
Ambitious plan to ‘eradicate’ hepatitis C...
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hat is a life worth to you? How about $100,000 to improve the plight of a single person?
HepatitisWA director Frank Farmer says the public response to the new treatments has exceeded expectations, but the work is far from over.
On March 1, 2016 the federal government added six new medicines for hepatitis C to the Pharmaceutical Benefits Scheme and pledged more than $1 billion funding for five years.
“It needs a lot of work, a lot of collaborations, and a lot of working closely with some populations that are difficult to reach,” he says.
Australia is the first country to give universal access to “revolutionary” direct-acting antiviral medicines. These new treatments have a successful cure rate of 90 to 95 per cent.
Farmer says maximising this opportunity in the present will prevent “an enormous” burden on health services and the community in the future.
Previously, Australians with Hepatitis C could only access interferon and ribavirin. The old treatments were extremely unpopular due to horrific side effects: nausea, diarrhoea, fatigue, depression, psychosis, and hair loss. Now it is as easy as a pill every morning for three to six months with minimal side effects. To treat one person costs about $100,000. Since March, 28,360 people have received treatment. Australia is on track to cure more people of Hepatitis C, also known as HCV, in 2016 alone, than in the past two decades. Australia has set itself on the eradication. But is it that simple?
path
to
Properly engaging priority populations such as injecting drug users and prison populations is essential. But it’s also complicated. 14
HepatitisWA Newsletter // December 2016
Frank Farmer and Nadia Cleber in front of HepatitisWA’s head office. Photo: Jonathon Daly. Hepatitis C is a blood-borne virus which affects liver cells. The immune response causes inflammation of the liver. It can lead to cirrhosis and liver cancer if left untreated. About 230,500 Australians live with HCV, and 700 die each year. Symptoms can take years to emerge as the liver gradually deteriorates.
HCV related diseases are the leading cause of liver transplants, and death from liver cancer (mainly driven by HCV) is rising faster than any other. In 2011, 80 per cent of newly acquired infections resulted from unsafe injecting drug use, such as sharing syringes, spoons, filters, or tourniquets. Drug addiction can affect the wealthy and educated just as easily as the destitute. It does not discriminate, but society does. Findings from the Report of Trends in Behaviour Supplement on Viral Hepatitis 2016 show discrimination from health workers towards injecting drug users with HCV lowers the chances of them accessing treatment.
An injecting drug user, McCormack acquired HCV through sharing injecting equipment. McCormack says many people in his life are unwilling to access treatment for HCV. “Things take a higher precedence,” he says. “If they only knew it was that easy I think there might be a lot more signing up. At the same time I guess ignorance is bliss.” McCormack says the non-judgmental nature of WASUA makes it an attractive avenue of treatment. “There is no need to feel ashamed. I’m actually happy and proud when I walk in there,” McCormack says.
Injecting drug users can lead somewhat chaotic lives which are often incompatible with the regimentation of a doctor’s schedule. The WA Substance Users Association operate a peer-based Needle and Syringe Exchange Program and HCV clinic Peer-based means its staff have some form of drug use experience or at the very least awareness. Inside its benign offices in Piccadilly Square sits a table full of bananas, apples, grapes and snacks. A yellow bin, with a picture of a cartoon needle and the word “disposal” stuck to it, is in one corner, and a water cooler in the other. The exchange is an important way to minimise harm because it offers a stable supply of sterile injecting equipment to drug users in exchange for the disposal of used equipment. In 2013 almost 5 million needles and syringes were distributed throughout WA, 62 per cent of these were through NSEPs. Simon McCormack has been receiving treatment for HCV at WASUA for the last three months. He is due for his last set of blood tests to determine if he has been cured. He wears a ‘Mack’ trucker hat, and a grey jacket with the sleeves rolled up always just below the creases of his arms.
Simon McCormack visits WASUA nurse Leanne Myers. Photo: Jonathon Daly. Hepatitis WA NSEP and HCV clinic co-ordinator Nadia Cleber says health care stigma is a huge barrier for priority populations. “My clients who are currently injecting drug users or have been, have had at least one instance when they have been discriminated against because of their injecting drug status or Hep C status,” Cleber says. “They are reluctant to access mainstream health services because of that.” “What we are offering here is fantastic, because it’s a community based treatment.” HepatitisWA Newsletter // December 2016
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FEATURE Cleber says 28 per cent of people who access HepatitisWA’s NSEP are indigenous. The HCV infection rate among Aboriginal and Torres Strait Islander communities has risen by 43 per cent in the past five years. Curtin University Centre for Aboriginal Studies director Marion Kickett says injecting drug use in Aboriginal communities is on the rise, and the prevalence HCV is a major issue. “From my experience within the community and different family groups, it’s because we are over represented in the prison system,” Kickett says. “This is a constant debate with the WA Department of Corrective Services. The department talks about this as a public health issue, because they don’t believe there should be fit packs [injecting equipment] in jail.” According to the Australian Bureau of Statistics, Aborigines and Torres Strait Islanders accounted for 27 per cent of the prison population in 2015. They represent just 2 per cent of Australia’s adult population. Currently there are 6,057 people in WA prisons. Of these, 1,038 have HCV. Since the introduction of new medicines, 15 prisoners have completed the new treatment and 44 are currently receiving it. University of New South Wales researcher Andrew Lloyd has conducted numerous studies on HCV within prison populations. Lloyd says the PBS arrangement is exciting because it gives prisoners special access to treatments. “At any one time we have 5 per cent of the infected population in prison. So you can definitely say that at least in theory we can scale up treatment in the prison dramatically and make a big impact on that elimination goal.” According to the WA Department of Corrective Services, the rate and prevalence of hepatitis C in WA prisons is 16 per cent. This statistic is based the National Prison Entrants’ Blood-borne Virus Survey 2010. But this fails to account for transmissions that occur within prisons through the sharing of
Professor Marion Kickett at Curtin’s Centre for Aboriginal Studies. Photo: Jonathon Daly. injecting equipment. Screening for HCV is voluntary but “encouraged”. On the department’s website, the blood-borne infection strategy states: “The prison health service is one of the biggest single notifiers of hepatitis in Western Australia. This is because of the high number of offenders who take part in injecting drug use before they are sent to prison.” Mark McKenna is a former WA prisoner who is being treated for HCV. McKenna, 44, has been in and out of prison since he was 13. McKenna says injecting drug use in prison is common. “There is not a day go past where someone isn’t getting drugs” he says. “They share every day with anyone. They just don’t care. Sometimes they don’t even rinse them out.” McKenna thinks a Needle and Syringe Program (NSP) would help. “They are going to use regardless,” McKenna says. “I’ve seen some homemade horrible ones. I’ve seen someone sharp up the end of an Art-liner. He made a plunger out of a thong and a cotton ear bud.”
Reproduced permission from Jonathon Daly at the Western Independent, November 09, 2016. 16 Source: HepatitisWA Newsletter //with December 2016 Available at www.inkwirenews.com.au/2016/11/09/ambitious-plan-to-eradicate-hepatitis-c
Lloyd says without adequate prevention strategies prisons will continue to be a major site of HCV transmission. “In some states and territories there is no opioid substitution therapy, and in every state and territory there is no NSP in prison,” Lloyd says. “The only notional prevention strategies are bleach or disinfectant provisions to clean injecting apparatus, and education, neither of which have got evidence to support their efficacy.” When asked why NSPs are not provided in WA prisons, the department responded: “It’s not something being considered by the Department of Corrective Services.”
Instead the department tries to reduce the spread of HCV by educating prisoners about transmission and providing condoms and dental dams. Farmer says to deny prisoners access to an NSP is to deny basic “human rights”. “We think about 40 per cent of people who go into prison are living with Hep C,” Farmer says. Farmer argues it is time to address the social stigmas and institutional inadequacies that stand in the way of priority populations.
“The rest of the world are really looking at us, the message is ‘don’t stuff it up’. We need to work together to bring down the barriers and improve people’s lives”. – Frank Farmer
BY JONATHON DALY.. HepatitisWA Newsletter // December 2016
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FEATURE
HEPATITIS B: IS A CURE POSSIBLE?
W
ith the momentum growing around hepatitis B drug discovery research, how far are we from a cure?
Closer than ever, according to Timothy Block, PhD, president and co-founder of the Hepatitis B Foundation and its research arm, the Baruch S. Blumberg Institute. He points out that hepatitis C, initially thought to be incurable, can now be cured with new combination treatments. “Hepatitis B is in a similar position,” Block believes. And the need for a cure has never been greater, with over 240 million people living with chronic hepatitis B infection worldwide, resulting in 1 million deaths per year from related liver failure and liver cancer. “Treatments are available,” explains Block, “but we have become a little too comfortable with the seven medications that are currently approved for use.” While these drugs are effective, the interferons have many side effects and the oral antivirals require lifelong use. Moreover, they work in only about half of the infected population, and reduce the rate of death due to liver disease by only about 40 to 70 percent.
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HepatitisWA Newsletter // December 2016
For those who benefit from treatment, the antiviral drugs prove that medications can be effective. However, there are millions who do not benefit and are still left vulnerable. “We should not accept that a significant number of people will still die from hepatitis B-related complications despite taking the current drugs,” Block declares. What would a cure look like? The current antiviral agents are similar and combinations do not offer any advantage. They have limited effectiveness against cccDNA, the seemingly indestructible “mini-chromosome” of the hepatitis B virus that continues to produce virus particles in infected liver cells, even in people being treated. A cure, therefore, would have to destroy or silence cccDNA and provide long-term protective immunity. Because one-drug treatments can lead to drug resistance, a cure would almost certainly involve combination therapy. With the recent advances in hepatitis B research, scientists are optimistic that another big leap in the search for a cure is possible if other complementary drugs can be found.
The Baruch S. Blumberg Institute of the Hepatitis B Foundation is at the forefront of research efforts to discover such new drugs.
“The years that we all have spent working towards a cure for hepatitis B have laid the groundwork for this final phase,” said Block.
Blumberg Institute at the forefront
“We are committing everything we have, every resource at our disposal, to developing the therapies that will ultimately improve the lives of all people living with hepatitis B worldwide and ultimately relegate hepatitis B to the history books.”
Blumberg scientists have played a key role in increasing understanding of the virus life cycle and are recognized leaders in drug discovery research that also includes designing and developing assays to screen for new drugs. “With our Drexel University colleagues, we are among the first, if not the only group, to identify a small molecule that inhibits hepatitis B virus cccDNA formation,” Block notes. This is significant because inhibition of cccDNA is considered essential in achieving a complete cure. Block is confident that a drug with this mechanism will eventually become available. In 2015, the Blumberg Institute licensed several of its discoveries to Arbutus Biopharma, the first company solely dedicated to hepatitis B drug discovery, and signed a three-year research agreement to work on novel approaches to developing a hepatitis B cure. “This unique partnership will allow us to move our discoveries more rapidly from the lab to the clinic,” Block explains. Adding to its drug arsenal, Blumberg researchers have used computer modeling to design and produce targeted drugs against hepatitis B and liver cancer. In another innovative approach, researchers are screening plant and fungal extracts from its Natural Products Collection, donated by Merck & Co. in 2011, and have already discovered two potential drugs that are active against hepatitis B. Getting close to the finish line “There has never been more optimism than right now that a cure is within reach,” says Block. “This is the goal of the Hepatitis B Foundation, so we are all very excited.” Blumberg researchers are building on recent discoveries that have heightened the momentum around finding a cure for hepatitis B and liver cancer: new screening methods to search for effective drugs; new ways to treat hepatitis B using different approaches to shut down the virus; a new blood biomarker that aids in the early detection of liver cancer; and a promising drug that selectively kills liver cancer cells in animal studies.
Baruch S. Blumberg Institute HBV Research Pipeline The Baruch S. Blumberg Institute (BSBI) of the Hepatitis B Foundation is leading the charge in developing innovative new therapies against hepatitis B. Among the products in the pipeline: cccDNA Inhibitors We are among the first, if not the only group, to identify the first small molecule inhibitor of HBV cccDNA, which has now been made highly active and is licensed to Arbutus Biopharma for further development. Capsid Inhibitors, “YES Kinase” Inhibitors We are using high-throughput screens and computer modeling to design and produce targeted drugs that include capsid inhibitors for HBV and “YES kinase” inhibitors for liver cancer. Immune System Activators We have developed a new HBV drug that works by activating an infected liver cell’s own immune system, which has been shown to be effective in animal studies. Natural Antiviral Agents We have screened thousands of plant and fungal extracts from our extensive Natural Products Collection and identified two new leads that show potential activity against HBV.
BY HEPB.ORG.. November, 2016 tinyurl.com/hepatitis-b-is-a-cure-possible Copyright © 2016 hepb.org
HepatitisWA Newsletter // December 2016
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HEALTH & LIFESTYLE
Hepatitis C & Food:
An Introduction to
Healthy eating
It is common for people with hepatitis C to worry about what they eat and whether their diet affects their liver. Generally speaking, there are no particular foods that people need to avoid or seek out, aside from avoiding alcohol and certain herbs and plants than can cause liver damage.
Role of The Liver The liver is one of the most important organs of your body. It is the factory that converts raw materials from your digestive system into substances that your body needs. It detoxifies harmful substances such as alcohol and helps remove waste products. The liver also makes bile which helps in the digestion and absorption of fats.
Hepatitis C & The Liver
good daily intake of vitamins and minerals you need to eat some food from all the food groups every day, varying your choices from day to day. Exercise may also make you feel better and improve your appetite. You don’t have to take it seriously, only regularly. Over consuming alcohol or other drugs can disrupt your day-today eating patterns and this may have a negative impact on your health.
HCV (the hepatitis C virus) uses materials from inside liver cells to reproduce. This Hepatitis C & Body Weight results in damages to the liver that is often mild but sometimes, more serious. Evidence is mounting that excess body fat contributes to liver disease (as well as Even if someone’s liver is not significantly cardiovascular disease). People with HCV damaged, they may still feel tired or ill. This may are advised to avoid becoming overweight. be due to the way the human body fights HCV. The best way to manage your weight is a long Healthy Eating & Lifestyle term approach of increasing the exercise you do Healthy eating is important as you generally along with maintaining a lower-fat, high-fibre feel better when you eat well. Healthy eating diet. Avoid rapid weight loss as this can be involves choosing a variety of foods. In the damaging to the liver. Contact a dietitian right balance, these foods will meet your body’s to discuss the best strategy for you. need for energy, growth and repair. To get a Article “Hepatitis C and Food - An introduction to healthy eating” re-printed with permission by Hepatitis NSW. 20 HepatitisWA Newsletter // (01 December 2016 2016) Strawberry image available under a creative commons license at www.sxc.hu. Available at www.hep.org.au November Photography by Andreas Krappweis Copyright © 2013.
Alcohol & Hepatitis C The risk of developing cirrhosis is higher for people with HCV if they also are heavy drinkers (for more information speak to your doctor or visit www.alcoholguidelines.gov.au). A reduction in alcohol intake should be the first step in any attempt to reduce the possible risk of serious liver damage.
Fats & Hepatitis C You don’t need to cut out all fats and oils just because you have hepatitis C – everybody needs some fats to make hormones and for body cells to function properly. Many people in Australia though, eat too much fat which is a risk factor for heart disease, diabetes and becoming overweight. People are generally advised to eat less fat.
Nausea & Loss of Appetite Here are some tips to help when you feel nauseous or have lost your appetite: • Eat small amounts, often. • Eat most when you feel hungry. • Try ginger ale or other ginger products. • Choose foods that contain lots of vitamins and minerals. You can meet your requirements in a smaller amount of food by eating foods like milkshakes or smoothies, yogurt, nuts, tofu, dried fruit, soy drinks, flavoured milk or cheese. • Try different tastes to stimulate your appetite, e.g. bitter, sour, salty, sweet. • Nutritional supplements may be useful if you are not eating well, or if you are losing too much weight.
If you feel sick or nauseous (i.e. feel like vomiting) and find that fatty food doesn’t agree Talk to a dietitian if nausea and loss of appetite with you, try avoiding such foods while you persist. Dietitians can also provide advice on feel nauseous. Reintroduce individual foods nutritional supplements. gradually to see which ones cause the problem. Continued over the page HepatitisWA Newsletter // December 2016
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HEALTH & LIFESTYLE
Dairy Foods Dairy foods are an excellent source of essential nutrients. It is hard to get enough calcium if you exclude milk products from your diet. Some dairy foods contain high levels of fat and if you want to reduce your fat intake, choose reduced-fat dairy products or calcium-enriched soy milk products.
Red Meat
Tea Tea and coffee have been enjoyed in many cultures for thousands of years. The active ingredient, caffeine, produces effects on the body (such as increased alertness) but these are usually temporary. There is no published scientific evidence suggesting that tea, coffee or caffeinecontaining drinks, consumed in moderation, cause particular problems for people with HCV.
Lean red meat is a valuable source of iron, protein Sugar and B group vitamins. There is no published scientific evidence to suggest that people with We are born with a strong liking for sweet hepatitis C are adversely affected by eating tasting foods. Although sugar is a source of red meat. energy (calories, kilojoules), it is better to obtain your energy from nutrient rich foods such as whole grain breads and cereals, Salt meats, fruits, nuts, fish, tofu or vegetables. All people in Australia are advised to eat less salt whether they have hepatitis C or not. Sugar enhances the flavour of many foods and You can do this by using less salt in cooking it is often found as an additive. Such and reducing salt use at the table. Many foods consumed in moderation should manufactured or processed foods such as not pose a health problem. There is no canned vegetables or sauces are high in salt. published scientific evidence to suggest that Try using low-salt or salt-reduced varieties of people with hepatitis C have particular these foods. problems metabolising (processing) sugar.
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HepatitisWA Newsletter // December 2016
All images available under a creative commons license at www.sxc.hu. Photography by Andreas Krappweis Copyright Š 2013.
Food colours & preservatives There is no published scientific evidence to suggest that people with hepatitis C have particular problems metabolising artificial colours or preservatives in foods. Avoiding all artificial colours, flavours and preservatives would severely limit your shopping choices and could add unnecessary stress to your life without any significant health benefits. Any people with proven sensitivity to particular colours, preservatives or foods should be vigilant, whether they have hepatitis C or not.
Vitamin & mineral supplements
Further nutritional information
There is evidence that antioxidant nutrients (such as vitamin C and E) can play a role in limiting the damage that HCV causes to the liver. Most people get their vitamins and minerals from fruit and vegetables. Additional supplements may be useful for people who do not eat a variety of foods from each food group.
Most people with hepatitis C will not experience serious liver damage. They need only take care about their food choices and alcohol intake to ensure their diet keeps them as healthy as possible.
If you have a level of liver damage or symptoms that require more specialised dietary advice, People with illness or injury have increased your GP or specialist should be able to vitamin and mineral requirements and refer you to a dietitian. may benefit from taking supplements. For further information on hepatitis C and If you take supplements, be careful not diet, please contact the Hepatitis Helpline on to exceed the recommended dose as (08) 9328 8538 Metro; 1800 800 070 Country. this may be harmful. Seek advice about whether you need nutritional supplements from an Accredited Practicing Dietitian.
Herbal treatments Some herbal treatments have been shown as beneficial to the liver (e.g. siymarin). Other herbs can damage the liver (e.g. germander, Teucrium chamaedrys) and some can interfere with prescribed medications. Complementary health practitioners can advise on possible herbal treatment options. It is recommended that you discuss all treatments you are considering with your GP. HepatitisWA Newsletter // December 2016
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S
EASY
ERVES
6
HEALTH & LIFESTYLE
ALTHY HE
MEXICAN STREET CORN SALAD This Mexican Street Corn Salad is a healthy, simple take on “Elote”, the delicious Mexican street vendor version of corn on the cob! Ingredients
Dressing • ½ cup (80 g) plain nonfat yogurt* • 1 Tbsp (15 mL) lime juice • 1 tsp (5 mL) honey • ½ tsp paprika • ¼ tsp cumin Salad • Splash of oil • 4 ears of corn (about 3 cups, 285 g of kernels), shucked and kernels removed • 1 clove garlic, minced • 2 Tbsp (30 mL) lime juice • ¼ tsp salt • 1 cup (200 g) canned black beans, drained and rinsed • 1 red bell pepper, seeded and chopped • ½ cup (35 g) chopped red onion • ½ cup packed fresh cilantro, chopped • ½ cup (88 g) cotija or feta cheese, crumbled
Prep time 10 minutes
COOK time 15 minutes
METHOD
1. Mix all dressing ingredients and set aside. 2. Heat oil over medium/high heat in a large saute pan then add garlic and corn. Cook about 15 minutes, flipping frequently, until corn begins to char a bit. Gently toss with lime juice and salt.** 3. In a large bowl, combine corn mix, black beans, pepper, onion, cilantro, and cheese. Drizzle sauce over and serve either warm or cold. Perfect over tacos, as a chip dip, or by itself!
Nutrition (PER SERVING*) Calories: 181 Fat: 4.6 g Carbohydrates: 28.6 g Sodium: 192 mg Fiber: 5.8 g Protein: 8.8 g
*If using Greek yogurt, add a dash of milk to thin it out. **Alternatively, cook the ears of corn on the grill, then remove kernels and mix into garlic, lime juice, and salt.
Recipe Live Eat Learn. Visit www.liveeatlearn.com/mexican-street-corn-salad 24 from HepatitisWA Newsletter // December 2016
HepatitisWA’s Deen Clinic is now open for hepatitis C treatments. Available to people who do not have a GP and who continue to use drugs.
100%
Bulk-Billing
Make an appointment on (08) 9227 9800. Our services include: • Hepatitis C testing • Hepatitis C treatment
134 Aberdeen St, Northbridge WA 6003
• Support
P: (08) 9227 9800
• Referrals
E: info@hepatitiswa.com.au W: www.hepatitiswa.com.au HepatitisWA Newsletter // December 2016
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WASUA’S DOMAIN
W
ASUA promoted safer injecting throughout Injection Infection Week 15th to 19th August in both the Perth and Bunbury needle exchanges. The aim of injection infection was to raise awareness of infections which are related to or caused by injection. The first and perhaps most common of these infections are abscesses. Abscesses (also referred to as boils or furuncles) are usually caused by staphylococcus or streptococcus bacteria. These bacteria are found on the skin of all people and are usually harmless unless the skin is broken and the bacteria enter the blood stream. Hence, those who inject are more at risk of developing abscesses than those who don’t. An abscess is literally a collection of pus under the skin, the result of the body reacting to the presence of the bacteria. The area will usually be red, swollen and painful. If the abscess is severe or not treated there is a risk of the bacteria spreading to other parts of the body through the blood stream and causing more severe infections such as endocarditis. Abscesses may be treated with antibiotics or by draining the abscess. Abscesses can also be caused by injecting and irritant or insoluble substance such as something your drugs are cut with. This can result in a sterile abscess, caused not by a bacteria but an irritant. They can occur anywhere on the body and not necessarily at the injection site. This type of abscess will usually go away by itself. Don’t be tempted to squeeze it as this may introduce bacteria which could result in a infection. Good injecting hygiene is the most effective way to prevent abscesses forming. This is why peer education recommends washing hands before injecting and swabbing the injection site (one swipe, one swab) before injecting. Another, potentially more serious infection is endocarditis. (endo = inside, card refers to the heart and ‘itis’ means inflammation). The bacteria, which most often causes endocarditis is staphylococcus aureus, the same bacteria which can cause abscesses and cellulitis. If this bacteria enters the blood stream it can lodge in the valves of the heart and as it multiplies can form colonies resulting in damage to the heart. Small pieces from the colony can also break off and enter the blood stream and spread to other organs such as the kidneys, lungs and brain. There are two types of endocarditis; acute and chronic. The acute type develops rapidly (1 – 2 days) and causes a high fever, chest
pain, shortness of breath and cough. Treatment at a hospital or your doctor is essential. The chronic form of endocarditis develops over a much longer period of time (up to a year) and symptoms include chills, night sweats, pain in muscles and joints, fatigue, headache, poor appetite and weight loss. A visit to your doctor or hospital is essential. Despite the seriousness of endocarditis it is very treatable as long as it is recognised early. Prevention of endocarditis is the same as for abscesses; good injecting hygiene, always using clean equipment, washing hands before injecting and always swab the injection site before using. Swabs are free from the needle and syringe exchange so make sure you have plenty on hand. Cellulitis is another skin infection which is associated with injecting drug use. Cellulitis, like endocarditis and abscesses is usually caused by staphylococcus or streptococcus bacteria and injecting drug use is a common risk factor. Cellulitis occurs when bacteria enter the blood stream though a cut or crack in the skin. Although the infection can occur anywhere on the body, the skin of the lower leg is most commonly involved. It usually appears as an area of redness with swelling and feels hot and sore to touch. More serious cases of cellulitis involve fatigue, dizziness, muscle aches and feeling generally ill. If cellulitis is not treated it can spread to other parts of the body. If you experience the symptoms of cellulitis you should seek medical help. It is usually treated with antibiotics and pain relief when necessary. Prevention of cellulitis is the same as for endocarditis and abscesses; good injecting hygiene, always using clean equipment, washing hands before injecting and always swabbing the injection site before using. If you have any scratches or insect bites or any break in the skin make sure you wash the area with soap and water or wipe with a swab (one swab one swipe) and cover the site until a scab forms. Resist the temptation to scratch or pick at the scab, as this increases the chance of the bacteria entering the blood stream. Remember swabs are free at WASUA so make sure you have plenty on hand. See the Do’s and Don’ts of Injecting to ensure you stay injection infection free and if you have any questions ask your friendly NSEP worker who will be happy to help.
BY WASUA Susan Carruthers (Hep C Community Development)
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HepatitisWA Newsletter // December 2016
DO’S & DON’TS OF INJECTING DON’TS
DO’S • • • • • • • • • • •
•
•
Do use a new sterile fit Do use sterile equipment (including swab, spoon, fingers etc...) Do wash your hands first Do use a clean area when preparing your mix Do use a clean area when injecting Do use a new swab for each injection site Do use a new swab every injection Do only swab in one direction Swab your spoon before using Do filter your mix Do use cotton wool when drawing up, before injecting or filtering, even when drawing out of a bag Do stem blood flow using and reduce bruising by applying pressure to the injection site (don’t use an alcohol swab) Do use filters such as sterile cotton, sterifilts, needle filters and wheel filters (ask staff for a demonstration and free trial of filters)
• • • • • • • •
•
• •
Don’t re-use or share needles or syringes Don’t re-use or share any other injecting equipment Don’t lick the injection site before or after injecting Don’t lick you fit/tip Don’t re-use a filter Don’t leave an infection to worsen, Do seek medical assistance Don’t use equipment if wrapper is unsealed or expired Don’t inject if bright red or frothy blood enters your fit... You have hit an artery! Stop and find a new site, a vein has dark red blood Don’t use an alcohol swab to stem blood flow by applying pressure to the injection site. The alcohol will prevent clotting and encourage continuous bleeding Don’t leave pre-mixed shots to stand at room temperature Don’t forget to filter
PERTH
SOUTH WEST
Van Phone 0417 973 089 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 & Thurs: 10am-4pm Closed Public Holidays
WASUA provides a number of services on premises at 22/7 Aberdeen St, Perth WA 6000, including: • • • • • • • • •
97 Spencer St, Bunbury (entry via Rose st) Opening Hours: Monday to Friday 10am - 2pm.
South West Mobile provides a mobile Needle Syringe Exchange Program (NSEP) at the following locations and times: Margaret River Busselton Jaycee Park, Bunbury Hudson Road, Bunbury Bunbury Hospital Manjimup Harvey Donnybrook Collie
Tues: 1pm-2pm Hospital Carpark Tues: 5pm-7pm Kevin Cullen Community Health Wed: 4:30pm-5:30pm Jaycee Park Wed: 5:45pm-6:45pm WA Country Health Service Wed: 7pm-8pm Dental Clinic Carpark Thurs: 5pm-6pm Hospital Carpark Thurs: 6pm-7pm Hospital Carpark Fri: 4pm-5pm Hospital Carpark Fri: 6pm-7pm Ngalang Boodja (Corner Forrest St & Atkinson St)
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 A confidential delivery service is also available throughout the southwest Safe injecting and safe disposal education and resources from Monday to Friday, for people who cannot attend the site locations. Hepatitis C/blood borne virus information and resources Phone 0408 946 762 to arrange a suitable time.
HepatitisWA Newsletter // December 2016
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