HepatitisWA Newsletter July 2017 by HepatitisWA

Newsletter Issue 19 | July 2017

Hepatitis C CURE available now FREE!

Please take one!

PERSONAL PERSPECTIVE | GOING VIRAL | HEALTH & LIFESTYLE

JULY 2017

CONTENTS

PERSONAL PERSPECTIVE

COMMUNITY NEWS

PROMOTIONS

06 Sharnee’s Story

04 Message from HepatitisWA’s Management

05 HepatitisWA Membership Form

A personal perspective by Sharnee Ryder.

FEATURES 10 World Hepatitis Day 2017 #SHOWYOURFACE TO ELIMINATE HEPATITIS The World Hepatitis Alliances’

Campaign for World Hepatitis Day.

12 Hepatitis C CURE available now HepatitisWA launches a new

campaign to coincide with World Hepatitis Day.

08 Going Viral A round-up of articles on viral hepatitis.

If you’re interested in becoming a member or renewing your membership, please fill out and return the annual membership form.

19 Deen Clinic Services

HEALTH & LIFESTYLE

20 HepatitisWA Services

16 Women and hepatitis C Reproduced with permission

24 Connect with HepatitisWA Connect with us on social media.

from Hepatitis Australia.

14 Welcome to the Deen Clinic A snap-shot of HepatitisWA’s

Written by Frank Farmer and Sally Rowell.

Deen Clinic.

18 Recipe: Winter Vegetable Tagine Recipe by Jill Dupleix from Delicious. Available from tinyurl.com/winter-veg-tagine

WASUA’S DOMAIN 22 Living with hepatitis C, No longer... Written by Diane Lloyd

06 2

HepatitisWA Newsletter // July 2017

(Community Development Worker)

LETTER FROM

THE EDITOR HepatitisWA is proud to promote our latest campaign in time for World Hepatitis Day which takes place around the world on July 28. We have launched our campaign (as seen on the cover page) ‘Hepatitis C CURE available now’ over a number of marketing platforms from billboards, to community newspapers, to cinema advertising, to radio, to online social media advertising with an overall aim of increasing awareness to the general public throughout Western Australia and a call to action to get treated and cured of hepatitis C. This is a special issue where we feature the people behind HepatitisWA’s Deen Clinic and we also feature a personal perspective of one of recently cured patients – Sharnee Ryder. She shares her experience with us regarding living with hepatitis C from the age of 17, to finding out about the Deen Clinic and being cured. In our health and lifestyle section, we feature an article on women and hepatitis C, and a healthy and delicious winter vegetable tagine recipe. Lastly, WASUA shares their own personal perspective with Community Development Worker Diane Lloyd sharing her story of being diagnosed with HIV and hepatitis C, and recently being cured of hepatitis C.

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 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 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 // July 2017

MESSAGE FROM ’s MANAGEMENT

As World Hepatitis Day approaches it is time to reﬂect on what has been achieved over the previous twelve months, and consider what still needs to be done. The Direct Acting Antiretrovirals (DAAs) for hepatitis C have been available for a year and a half and we have seen some amazing results. The Kirby Institute reported that up until December 2016 over 30,000 people had been treated nationally, which indicated that Australia was on track to eradicate hepatitis C by 2026. Initially Western Australia lagged behind most other states and territories, however recent anecdotal evidence suggests we have picked up, and in fact WA has the fastest up-take of prescribing by GPs in the country. This is good news as allowing GPs to prescribe was key to enabling all people living with hepatitis C improved access to hepatitis C treatments. The news that from June 2017 Nurse Practitioners are able to prescribe hepatitis C treatments is another boost to accessibility for people seeking treatment. In September 2016 HepatitisWA established the Deen Clinic, a hepatitis C treatment clinic staffed by dedicated and committed people, including two GPs, a Gastroenterologist, a Nurse Practitioner and a clinical coordinator. You can meet each of these amazing people in this addition of the newsletter. We are currently running three half day clinics per fortnight, and are hoping to extend this in the future. Whilst we continue to encourage people to access their GP for treatments we know that some people either don’t have a GP, or their GP isn’t currently prescribing, or they don’t want to go to their GP about this health issue, so we are pleased to be able to provide an alternative service. We are also aware that there are a number of organisations such as WASUA and Next Step who are also providing a great service to treat people. All in all things are going reasonably well, however there are some areas that need to improve in order to meet the elimination target. One of those is access to hepatitis C treatments for people who are incarcerated. We welcomed the initiative by PBS to keep the treatments as an S100 scheduled drug to ensure that prisoners would not be disadvantaged, however the logistics associated with providing treatments in prison settings have proved challenging. More collaborative work needs to be done between all players to ensure that prisoners with hepatitis C are being offered the same access to treatment as people in the community. Given the high rates of hepatitis C in prisons, effective access to treatments must be achieved or we are ﬁghting a losing battle. We are proud to launch our World Hepatitis Day Campaign which is to date the biggest campaign that we have produced. We feel that this World Hepatitis Day needs to keep the focus on hepatitis C treatments and the cure. Keep your eyes and ears open and we would love feedback if you see or hear any of our advertising.

by Management

HepatitisWA Newsletter // July 2017

MEMBERSHIP RENEWAL

ABN 42743157642

MEMBERSHIP APPLICATION 2017 – 2018 Please complete your details below in block print, cut-out and return with payment I (Mr/Mrs/Ms/Dr): _______________________________________________________ Title First Name Last Name Address: _______________________________________________________________ or Name of Organisation: __________________________________________________ Address: _______________________________________________________________ Residential or postal address – required under section 27 of the Associations Incorporation Act (1987) apply to become a membership of HepatitisWA (Inc). I agree to uphold the objects of the Association as stated in rule 3(1)(a)-(f). Signature:___________________________ Date:__________________________ Please tick your membership category

Payment options

Unwaged

$11.00 incl. GST

1 – Attach cheque or money order made payable to HepatitisWA

Waged

$22.00 incl. GST

or 2 – Pay by EFT - attach copy of EFT receipt to

Associate/Organisation

$55.00 incl. GST

Renewal Form

BSB 066118 Acct 10021906 HepatitisWA and

Mail to:

HepatitisWA (Inc) PO Box 67 Francis St, Northbridge WA 6865

or 3 – Pay in person at

HepatitisWA 134 Aberdeen St, Northbridge

HepatitisWA (Inc) is an income tax exempt charitable entity and deductible gift recipient. Your membership and ﬁnancial support enables us to continue our work in responding to hepatitis. Our quarterly newsletter, the HepatitisWA Newsletter, which carries the latest information on hepatitis C and related viral hepatides, is forwarded to all our members.

HepatitisWA (Inc) PO Box 67 Francis St, Northbridge WA 6865

t (08) 9227 9800 f (08) 9227 6545 email info@hepatitiswa.com.au Information (08) 9328 8538 Metro - 1800 800 070 Country Web www.hepatitiswa.com.au HepatitisWA Newsletter // July 2017

SHARNEE’S STORY Thirty-eight year old Sharnee shares her story on being diagnosed with Hep C, finding out about HepatitisWA and the Deen Clinic, receiving treatment, and being “cured”. When were you first diagnosed Why did you come to seek for hepatitis C? treatment at the Deen Clinic and how did you find the experience When I was 17, I was diagnosed here? with hep C. Well, my partner was in prison and he found out about How did you feel about the HepatitisWA through your people diagnosis, and how did it affect who were offering the course you, your family and friends? (The HIP HOP Program*), and I let my mum and sisters know and they mentioned that HepatitisWA that’s about it. And my partners – offered treatment for hep C – whoever I was with at the time, I didn’t even know all these because I had it for so long. I let years that this was here – never them know but they wouldn’t tell heard of it, so as soon as I heard anyone else because I felt about it, I contact you guys, and embarrassed about it and 2 weeks later I was on treatment. because the people who I was around (people in the drug How was the treatment for you – scenery). A lot of people would did you have any side-effects? speak down on people who had hep C, so you kind of kept it I had headaches in the beginning, quiet, pretend that you haven’t but I just took the tablets at night got it and you don’t want to let so I didn’t have to go through the people know because then they’ll headaches – it was easy… no look down at you. It was horrible. other side-effects, it was simple. 6 HepatitisWA Newsletter // July 2017 Source: Story by Sharnee, interview conducted by Jacqueline. Story is published with permission from the author.

PERSONAL PERSPECTIVE

I’ve got 2 little kids, and I just know that I’m going to live longer now. How do you feel now that you’ve completed the treatment? I feel really good. I’m really happy. I always had headaches and I’d always felt sick, and I couldn’t exercise or do things like that, but now I feel like I’ve got a lot of energy and I feel good, because I’ve got 2 little kids and I just know that I’m going to live longer now and my kids are going to be safe. It just feels good not having it anymore.

*HepatitisWA provides prisoner education through the HIP HOP (Health In Prison, Health Outta Prison) Program. We provide sexual health and blood-borne virus prevention education to assist people in prison or detention to stay safe. If you have hepatitis C and would like to get treatments through our Deen Clinic then please contact our Clinic Coordinator, Jacqueline on (08) 9227 9800.

I want to thank you – you guys (HepatitisWA), for helping me. HepatitisWA Newsletter // July 2017

GOING VIRAL A ROUND-UP OF ARTICLES ON VIRAL HEPATITIS HEP A AND B VACCINE

SEATTLE CHILDREN’S

SHORTAGES CONTINUE

PLAYS ROLE IN HEP C

he combined adult hepatitis A and B vaccine will be in short supply for private patients, GlaxoSmithKline has advised. The pharmaceutical giant is anticipating an “intermittent stock out” for Twinrix Adult (combined hepatitis A and B) throughout July. In its statement, GSK says it understands the reduced supply may be “distressing” for private patients needing to vaccinate for occupational reasons or due to travel to hepatitis-affected areas. Meanwhile, GSK says production of hepatitis B vaccine Energix-B Adult has returned to normal but it will take time to “rebuild capacity”. The TGA’s medicines shortages website states the vaccine shortage will continue until 30 January next year. However, GSK says it is unable to confirm a re-supply date. Energix-B Paediatic and Twinrix Junior vaccines have not been affected by the shortages and are still available. The shortages have not impacted the supply of GSK vaccines containing hepatitis B to government programs.

PHARMACY NEWS.. Jul 10, 2017 Pharmacy News tinyurl.com/hep-B-vaccine-shortage

DRUG APPROVAL FOR TEENS (US ARTICLE)

ntil recently the only option to fight hepatitis in pediatric patients was an injectable medicine with terrible side effects and poor results. Now a two-drug combination has been approved by the FDA for children down to the age of 12. “He became very, very ill, he was stumbling muscle fatigue just a lot of pain,” said Laura Mills, mother of a hepatitis C patient. Mills was still shaken, remembering her son Talon HendricksonZimmerman having a bad reaction to a medication called interferon. The family had hoped that would cure his hepatitis C, a virus he received from his birth mother and affects between 20,000 and 40,000 children in America. “There is progression by this virus and injury to the liver so that we know in the pediatric age range approximately 2 percent of children will develop cirrhosis, which is the most severe form of scarring of the liver. We know that approximately 20 to 30 percent will have significant information that will lead to scarring, so in their adult life they are at risk” said Dr. Karen Murray, a hepatologist at Seattle Children’s. Murray has been caring for Hendrickson-Zimmerman since he was a baby. After the first attempt at a cure had failed, Murray enrolled Hendrickson-Zimmerman in another study that focused on the use of drugs, Sovaldi and Harvoni, to eliminate the hep C virus in children. Both drugs had been approved back in 2014 for adults with nearly 100 percent success rates.

In April the FDA officially approved the two-drug combination for children down to the age of 12. Research data from Amsterdam shows that the same drug combination is safe for children as young as 6 years old. There is ongoing research for children between 3 and 6 years old. “Direct-acting antivirals oral medications are taken for 12 sometimes 24 weeks. They are oral once a day, and they have a very low well-tolerated side effect profile,” said Murray. Hendrickson-Zimmerman took two pills a day and was only two weeks into his 12-week trial when his condition began to improve. “He was amazing, just absolutely amazing, no side effects, no health issues. He went to school full-time,” said Mills. His treatment started in January 2016, and now the hepatitis C virus is no longer detectable in Hendrickson-Zimmerman’s body. “I think we all cried that day coming home, and he said, ‘Is this what it feels like to be a normal boy?’” said Dianne Rinesmith, HendricksonZimmerman’s grandmother. Hendrickson-Zimmerman’s family is proud to have been a part of a study that will help other children suffering from hep C, potentially saving lives and removing the stigma of having a communicable disease. “He’s got a future,” said Mills while beaming at her son. “He’s got a better life. He can think about things down the road: Marriage, girlfriends, sports, without the stigma of having hep C.”

KING5.COM.. July 11, 2017 www.king.com tinyurl.com/hep-c-drugs-for-teens

HepatitisWA Newsletter // July 2017 Disclaimer: The news articles and excerpts displayed in the HepatitisWA Newsletter remain the copyright of the original authors and news publications.

COMMUNITY NEWS

ALL NEWBORN BABIES IN THE UK TO BE GIVEN HEPATITIS B VACCINE (UK ARTICLE)

very child born from August 1 will be vaccinated against hepatitis B - the virus which can cause liver cancer and cirrhosis - after health watchdogs have warned of a spike in cases in the UK. Newborn babies will be inoculated against the cancer-causing virus, as part of the 5-in-1 ‘Hexa’ jab that protects them from diphtheria, tetanus, whooping cough, polio and haemophilus influenzae type b bacterial infections. Every baby born after the start of August will receive several doses of the ‘Hexa’ jab, at four, eight and 16 weeks. Several other countries already offer the Hep B jab after the World Health Organisation recommended in 1992 that all be immunised against the virus, and Britain is one of the last European countries to fall in line with the advice. Hepatitis B is spread through blood and bodily fluids, meaning that it can be spread through sex, infected needles or sharing a toothbrush. It often doesn’t cause any obvious symptoms in adults and typically passes in a few months without treatment, but in children it often persists for years and may eventually cause serious liver damage. Public Health England (PHE) said the decision to inoculate all babies on a mandatory basis was taken because a cost effective

combination available.

vaccine’ was

now

The aim of vaccination of babies will be to wipe out the disease over the long term by protecting future generations from infection. The infection is less common in the UK than other parts of the world, but health watchdogs have warned that cases in the UK are rising. Sema Mandal, a consultant in immunisation, hepatitis and blood safety at Public Health England (PHE) told The Guardian: “This has had a major impact on preventing infection in many countries. While hepatitis B is relatively uncommon in the UK, it is a major cause of cirrhosis and liver cancer globally,” she said. “From this autumn children in the UK will also be able to benefit from this safe and effective vaccine.” Worldwide, 250 million people are infected with hepatitis B, while it also kills 900,000 people a year. The virus can survive outside the body for up to seven days, meaning objects contaminated with dried blood pose a risk. Most infections in the UK are caused by injecting drugs or having unprotected sex with multiple partners.

EVENING STANDARD.. July 10, 2017 Evening Standard http://tinyurl.com/UK-hep-B-jab

FROZEN BERRIES HEP A CASES INITIALLY CLEARED BY COMPANY TESTING

rozen berries linked to 3 new hepatitis A cases were originally cleared by company testing before they went out for sale last October, Australia’s food safety agency says.

The 300 gram bags of Creative Gourmet Mixed Berries are being re-tested after being linked to hepatitis A cases in Victoria, South Australia and Queensland. Food Standards Australia-New Zealand (FSANZ) chief executive Glen Neal said it was concerning the original tests failed to pick up a problem, but the links to hepatitis appeared to be limited to the small batch of bags in question. “There is certainly no evidence to suggest that any other berries are involved, or indeed that there is an ongoing problem here,” he said. The berries were sourced from Canada and China and imported in February 2015. In February 2015 dozens of people contracted hepatitis A after eating frozen berries made by the Nanna and Creative Gourmet brands, thenowned by Patties Foods. “Understandably people will be concerned about this [latest incident] and it does seem like ‘here we go again’,” Mr Neal said. Mr Neal said the berries involved in the latest recall were imported prior to the current imported food requirements being put in place. “But I would say that the berries involved in this particular recall were imported in February 2015, just a few days before the prior incident occurred. New legislation to further reform Australia’s food testing powers was introduced to Parliament this week, following a review of the current regulatory system. The batch involved in the latest recall has an expiry date of January 2021.

ABC NEWS.. June 3, 2017 ABC News. tinyurl.com/hep-a-frozen-berries HepatitisWA Newsletter // July 2017

FEATURE

WORLD HEPATITIS DAY 2017 #ShowYourFace to eliminate hepatitis

he elimination of viral hepatitis has now been firmly put on the map. At the 69th World Health Assembly in Geneva, 194 governments adopted WHO’s Global Strategy on Viral Hepatitis, which includes a goal of eliminating hepatitis B and C in the next 13 years. The community responded by launching NOhep, the first ever global movement to eliminate viral hepatitis by 2030.

achieve elimination – so to highlight this, we’re putting a human face to elimination of viral hepatitis.

On WHD 2017, we can build on this momentum and accelerate progress towards achieving the goal of elimination by 2030.

#ShowYourFace is a personalised polaroid photo campaign focusing on individual human faces to highlight that hepatitis is relevant to everyone, everywhere in the world and that helping to eliminate it is something we can all support. Together we can all put a human face to the elimination of viral hepatitis.

ELIMINATE HEPATITIS is a simple call to action that everyone can get behind. Regardless of your priorities, the theme can be easily adapted for local use; to achieve elimination, greater awareness, increased diagnosis and key interventions including universal vaccination, blood and injection safety, harm reduction and treatment are all needed. Every activity that addresses viral hepatitis is a step towards eliminating it. No matter what your plans are to mark WHD, be it a rally or press briefing or testing events, they can all come under the theme of Eliminate Hepatitis. The elimination of viral hepatitis is not just a public health goal – it is an individual goal for millions of men, women and children across the world. Every single person could be affected by viral hepatitis and we all have a part to play to 10

To encourage people to feel empowered, personally connected and understand their role in elimination, we are bringing the ELIMINATE HEPATITIS theme to life through the #ShowYourFace campaign.

Individual human faces are accompanied by I AM statements, powerful personal messages that aim to make people feel empowered, personally connected and understand their role in elimination. I AM statements highlight the individual actions being taken to meet the 2030 goal or stress the emotions felt by those impacted by hepatitis to encourage others to take a stand. Your I AM statement could focus on… What you are doing to eliminate this deadly killer, e.g, I AM HELPING OTHERS, I AM CONTRIBUTING. What you have done to help meet the 2030 goal, e.g, I AM RECOGNISED, I AM DETERMINED. Encouraging others to take a stand in the fight against hepatitis, e.g, I AM STRONG, I AM FREE.

HepatitisWA Newsletter // July 2017

Source: World Hepatitis Alliance. Available at www.worldhepatitisday.org/en/2017-campaign (5 July 2017).

HepatitisWA Newsletter // July 2017

Hepatitis C CURE

HepatitisWA has launched a new campaign to coincide with World Hepatitis Day on July 28. The campaign â&#x20AC;&#x2DC;Hepatitis C CURE available nowâ&#x20AC;&#x2122; aims to create awareness to the general public in Western Australia. It is estimated that there are more than 200,000 people living with chronic hepatitis C in Australia. The good news is hepatitis C can be cured for most people. The new medicines, known as direct-acting antivirals 12

HepatitisWA Newsletter // July 2017

(DAAs) are taken orally, are more effective and have less side-effects. The number of weeks that people need to be on treatment has also reduced, the medicine is effective in curing hepatitis C in more than 90% of people and is available for free to all Australians*.

*The Australian Government has listed the medicines on the Pharmaceutical Benefits Scheme (PBS). You will be charged the usual co-payment price you pay for the dispensing fee of each prescription.

available now

FEATURE

HepatitisWA has launched the campaign through a variety of marketing channels, from billboards, buses and bus shell ads across Perth CBD, to radio adverts over a number of metro, regional and Indigenous radio stations, print ads on all community newspapers (metro and regional), cinema and social media advertising. For more information on treatments, please visit www.hepatitiswa.com.au or contact your GP.

HepatitisWA Newsletter // July 2017

WELCOME TO THE

DEEN CLINIC MEET DR LINDSAY (Gastroenterologist)

MEET DR DAVID (General Practitioner)

Background Information I’ve been working with hepatitis C really, before it first was discovered. I saw my first patient who might had been at risk of catching hepatitis C around 1989, which was soon after the virus was first described, and I was involved in the first Australian study of hepatitis C in 1991 – I’ve been involved in many studies of hepatitis C treatments and social considerations of hepatitis C since, and I’ve seen the field really change over time, till now, such simple, effective, tolerable, one-stop treatments. It’s been a fantastic progression, and I’ve been part of that all the way.

Background Information I graduated a long time ago from the University of WA. I then worked at Princess Alexandria Hospital for 4 years and then another 4 years at Royal Perth Hospital. I then decided to get into law, so I did a degree in law and then practiced for 20 years. It got really hard to be both a doctor and a lawyer so I had to give up medicine for 15 years.

Why do you work in this ﬁeld? I like the range of people who might have hepatitis C – some of them might come from different or challenging lifestyles, and some of them continue to have that type of different lifestyle. I ﬁnd it interesting, challenging and also rewarding. What’s it like working at the Deen Clinic? The Deen Clinic is great! The clients are often still on the road to getting their lives a bit more organised and less chaotic, but the ones that were screened for treatment have all been compliant patients with their treatments, and the results we’ve had so far are all good. All the patients that I am aware of that we’ve treated have all had good outcomes and been cured!

HepatitisWA Newsletter // July 2017

Why do you work in this ﬁeld? Eventually I decided to get back into medicine and was able to work at Charlie Gairdners Hospital for 6 years and then back with Royal Perth Hospital. Currently I work for Street Doctor and Passages in Northbridge. I like working in this ﬁeld because you work with a range of people from the community that have a very interesting case-mix. What’s it like working at the Deen Clinic? I like working at the Deen Clinic because it’s friendly, it’s supportive, you have people here who know what they’re doing and the staff are street-smart when it comes to our patients. We have a huge case-mix of clients that don’t know where they got their hepatitis C from – they could have contacted from sharing instrumentation or could have gotten a bad tattoo. Then you have people who have been injecting drugs for years. The staff at HepatitisWA know their clientele, plus, it’s located in a prime location in the middle of the community.

FEATURE

MEET DR NADA (General Practitioner) Background Information I am a GP, and have worked in Perth for around 4 years. I have an interest in mental health, Aboriginal health and treating marginalised people, and have worked mostly in these areas. Why do you work in this ﬁeld? It is very rare to be able to cure a chronic disease in General Practice. In the practice I last worked at, even the most marginalised of patients were cured of chronic hepatitis C with the newer treatments. People feel better after completing the treatment, they medically improve and the mental burden of hepatitis C goes away. This is such a great thing to be a part of and, so I continue to want to be a part of it. What’s it like working at the Deen Clinic? The Deen clinic is a very organised and welcoming workplace. By the time I see a patient about their treatment, most of the groundwork has been done by Jacqueline. The positive vibe of the clinic allows people to be open about their history and their understanding of hepatitis, which makes treatment very straightforward. Good relationships with imaging and pathology providers means there is minimal out-of pocket cost for the patient, which is another positive.

MEET JACQUELINE (Clinical Care Coordinator)

I’m so grateful that the government is funding the treatment for all adults with the virus, as its life changing and the happiness on the faces of our clients leaving the doctor’s ofﬁce with their SVR12 negative blood tests results is beautiful to see. Why do you work in this ﬁeld? I value working with and supporting the most vulnerable in our community. Health is one of the most important aspects of a person’s well-being. Also working with people who have felt embarrassment and shame for years over their diagnosis, who can come to our clinic and receive non judgmental holistic support, access treatments and move on with their lives without HCV impacting on their lives. What’s it like working at the Deen Clinic? I thoroughly enjoy working at HepatitisWA. Our work place is such a supportive one and my work colleagues are some of the most amazing people I have ever worked with. Our doctors at the clinic are brilliant – they have the upmost care and respect for our patients. I feel it’s a privilege to be a part of a team that is curing hepatitis C.

MEET RICK (Deen Clinic Patient) How did you hear about HepatitisWA? I come to HepatitisWA to visit and access the Needle Syringe Program and to get my ﬁtsticks and sometimes they have free food which isn’t so good for my waistline. Why did you decide to seek treatment at the Deen Clinic? I knew about the old treatment and the terrible side-effects that came with them and thought no, bugger it, not interested. When I was told about the new treatments and that they had no side effects I decided to give it a go. It wasn’t that hard and it really was just a matter of setting my phone alarm to the same time every day as a reminder to take the pill. What has your experience been like here at the Deen Clinic? I like coming into the Deen Clinic for the treatments and if I fall of the wagon every now and again I can get some ﬁtsticks.

Background Information I started work with Hepatitis WA in March 2016 as a Prison Education Ofﬁcer. Working in the drug and alcohol, mental health and homelessness sector for several years, I saw the impact hepatitis C had on my clients and at times the limited knowledge they had on harm reduction and transmission of the virus. I wanted to make a difference by providing education to the most at risk groups. I started as the Clinical Coordinator at the Deen Clinic in November 2016 and it is amazing to be part of a team that enables people to be cured of HCV.

I’ve now ﬁnished treatment and am waiting for my ﬁnal blood test to show if I have cleared hepatitis C. I’m feeling good and positive about the outcome.

If you have hepatitis C and would like to get treatments through our Deen Clinic then feel free to contact our Clinic Coordinator, Jacqueline on (08) 9227 9800 for an appointment. HepatitisWA Newsletter // July 2017

Menstruation Menstrual fluid contains blood and other body fluids. As hepatitis C is transmitted by blood-to-blood contact, there is in theory the possibility of transmitting hepatitis C

through

contact

during

menstruation. However, the risk of heterosexual or female-to-female sexual transmission is extremely low and there is no evidence that sex during menstruation increases risk of sexual transmission. In theory, having sex while menstruating can increase the risk of transmitting hepatitis C if your sexual partner has any open cuts, wounds or abrasions.

Using

sex,

condoms

and

dams

for

with

oral male

partners will reduce the risk of blood-to-blood contact. Following

standard

precautions

for infection control will lower the risk of transmitting hepatitis C through menstruation. This includes disposing of used tampons and sanitary pads in hygienic disposal units or in leak proof plastic bags in the general rubbish. Most

womenâ&#x20AC;&#x2122;s

periods

not

change because they have hepatitis C, although some find they miss a

WOMEN AND

HEPATITIS C Women with hepatitis C have a number of specialised needs related to their reproductive and sexual health. Women need accurate information to assist them to make informed decisions about their health care needs. The impact of hepatitis C on the reproductive and sexual health of women is not well understood and warrants further research.

period or have shorter periods. It is important to understand that any change in your menstrual cycle may not be related to having hepatitis C. Any change in a womanâ&#x20AC;&#x2122;s menstrual cycle should be discussed with a doctor, as it may or may not be related to hepatitis C.

Birth control The oral contraceptive pill is fine for the vast majority of women with hepatitis C however if you have severe liver disease, you may not be able to tolerate the oestrogen

16 HepatitisWA Newsletter // July 2017 Source: Reproduced with permission from Hepatitis Australia. Image licenced via Photodune. Available at www.hepatitisaustralia.com/living-with-hepatitis-c/women-and-hepatitis-c (5 July 2017)

HEALTH & LIFESTYLE hormones that are in the oral contraceptive pill or in hormone replacement therapy (HRT). This is because the liver may have problems breaking down these hormones. Please consult your doctor for further information on the use of the oral contraceptive pill or HRT. Women with hepatitis C with severe liver damage, or who are experiencing significant symptoms,

can be detected by PCR testing as early as 2–3 weeks. So, if parents are concerned they can ask for this to be done after 4–6 weeks, with follow-up testing if negative. Pregnancy is also not considered to cause deterioration of liver disease in women who have hepatitis C.

implants and barrier methods such as the diaphragm.

Women with hepatitis C on treatment (pegylated interferon* and ribavirin) are required to use two forms of contraception (one for each partner) to ensure they do not become pregnant during their treatment, and for six months following the end of treatment. This is because pegylated interferon and especially ribavirin can cause birth defects.

It is important that all these options are explored with

Breastfeeding

should discuss the use of the contraceptive pill with their doctor. There are other forms of contraception that can be explored. This includes hormone injections or

a trusted doctor to find what is best for your situation.

Menopause Just as oestrogen hormones in the oral contraceptive pill can cause problems for women with hepatitis C, hormone replacement therapy (HRT) may also not be well tolerated. The hormonal changes that women with hepatitis C experience as part of menopause are not all associated with the virus. Seek the advice of a doctor or an endocrinologist (a hormone specialist) for any problems experienced with menopause and HRT.

Pregnancy Hepatitis C does not reduce the likelihood of a woman becoming pregnant. The risk of hepatitis C transmission from mother to child is low, about 6%. Hepatitis C is more likely to be transmitted during birth than while the baby is inside the mother. Women with low levels of the virus in their blood are unlikely to transmit hepatitis C to their baby. Women with high levels of the virus, those with serious liver damage or those in the acute phase of infection, have a higher risk of transmitting hepatitis C to their baby. A baby born to a mother with hepatitis C will inherit the mother’s antibodies and test antibody positive until the child is about 15–18 months of age. In most cases, the child’s hepatitis C antibodies naturally disappear after 18 months. Therefore, testing a baby for hepatitis C is not recommended until the baby is older than 2 years. In saying this though, infection

There are no confirmed reports of hepatitis C transmission from mother-to-baby by breast milk. Current scientific opinion remains that there is no significant evidence of HCV transmission through breast-feeding. Scientists have found traces of the virus in breast milk and colostrum (the breast fluid produced by the mother in the first few days of breastfeeding) but not enough to transmit hepatitis C. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists currently recommends that breastfeeding should not be discouraged, as no cases of hepatitis C transmission have been documented by this route. Damage to the breast such as cracked nipples could pose a possible risk to the baby if blood-to-blood contact occurs through small tears or scratches in or around the baby’s mouth. It is recommended that women with hepatitis C who are breastfeeding should express and discard their breast milk while their nipples are cracked. Treat cracked nipples so they do not bleed and seek help from a breastfeeding counsellor or nurse lactation consultant to discuss ways of preventing cracked nipples. Breast milk supplies a balanced food supply for the baby, as well as protecting the baby from many illnesses especially in the first weeks, however, the final decision whether to breastfeed is entirely up to the mother. Gifford, S. M., O’Brien, M. L., Bammer, G., Banwell, C. & Stoove, M. (2003). Australian women’s experiences of living with hepatitis C virus: Results from a cross-sectional survey. Journal of Gastroenterology and Hepatology, 18, 841–850

17 HepatitisWA Newsletter // July 2017 *HepatitisWA acknowledges that direct-acting antivirals (DDAs) are readily available in Australia as current and preferred hepatitis C treatment options so pegylated interferon would not be applicable in this case.

CAP

VE ER S

LE C AB

OK O

HEALTH & LIFESTYLE

ALTHY HE

WINTER VEGETABLE TAGINE Brighten up a winter’s day with a vibrant vegetable tagine. The slow, gentle cooking brings out the sweetness of delicious vegetables, apricots and dates. Ingredients • • • • • • • • • • • • • • • •

1 tablespoon olive oil 2 onions, thinly sliced 2 large carrots, peeled, cut into 8cm lengths 1 large parsnip, peeled, cut into 8cm lengths 300g sweet potato, peeled, cut into 2cm pieces 2 tablespoons tomato paste ½ teaspoon cayenne pepper ½ teaspoon ground saffron 1 teaspoon each ground ginger and turmeric 2 cinnamon quills Vegetable stock or water to cover 400g canned chickpeas, drained, rinsed 2/3 cup (100g) dried apricots 8 pitted dates 2 tablespoons honey 2 tablespoons chopped flat-leaf parsley or coriander • ½ cup (40g) flaked almonds, toasted • Harissa and couscous, to serve (optional)

METHOD

1. Heat oil in a large flameproof casserole over medium heat. Add onion and cook, stirring, for 5 minutes or until softened. 2. Add carrot, parsnip, sweet potato, pumpkin, tomato paste, cayenne, saffron, ginger, turmeric and cinnamon quills. Pour in enough vegetable stock or water to just cover and bring to a gentle simmer. Cover and cook gently for 45 minutes. 3. Add the chickpeas, apricots, dates, and honey. Season, then simmer for a further 20 minutes or until vegetables are tender and the mixture is thick and soupy. 4. Scatter with herbs and almonds. Serve with harissa and couscous, if desired.

Prep time 30 minutes

COOK time

1 hr 10 minutes

Recipe Jill Dupleix from Delicious. 18 by HepatitisWA Newsletter // July 2017Photo credit: Steve Baxter. Visit www.tinyurl.com/winter-veg-tagine

Disclaimer: The copyright of this article and images remains with the original authors and publishers, unless otherwise stated.

HepatitisWA’s Deen Clinic is now 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 • 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 // July 2017

HepatitisWA Newsletter // July 2017

WASUA’S DOMAIN

LIVING WITH HEPATITIS C NO LONGER...

his has been a very long journey with my health. I was diagnosed with HIV in 1986 and diagnosed with hepatitis C (Hep C) in 1992, but I would have contracted hepatitis C at the same time that I contracted HIV, as a result of sharing injecting equipment. I have to say it hasn’t always been easy, not so much the physical symptoms but more the stigma, discrimination and acceptance. Over the years I have been very proactive in the sector. I am currently on the board of NAPWHA – National Australian People Living with HIV/ AIDS and Femfatales – a national committee for women with HIV. Having said all this, my health status and drug use was a benefit when applying for a job at WASUA. With having lived through the experience of injecting drugs and living with hepatitis C it made me a good fit to be part of the WASUA team. WASUA is 22

HepatitisWA Newsletter // July 2017

a peer-based organisation and I am happy to be open as a peer. The best part is the acceptance and the non-judgement attitude that I get from the team at WASUA. I feel my second home is RPH – Royal Perth Hospital, with the neverending appointments for HIV/Hep C and a few operations I have needed along the way. As I found out about my HIV status well before my Hep C, that was always my main focus re my health. I was also diagnosed with diabetes which added yet another appointment at RPH, and another tablet. I am on meds for my HIV and at the end of last year I had a serious conversation with Immunology (HIV), to look at going on the new hepatitis C treatments. Due to my other health issues I knew mine could be a little more complicated with the different tablets I am on. What could be taken only in the morning, what’s better at night, what can/can’t be taken at the same time as others? That is the only reason I did my treatment with RPH rather than

“My advice is run... don’t walk get onto the hepatitis C treatment as soon as you can!”

WASUA. As I am open about my status and starting treatment, it was a lot easier at work. The staff at WASUA was also very understanding and supportive. It was great to have Leanne our Nurse to speak to just for support and any questions. So not only did I have a daily pill box, it was broken down to am/pm, can be taken with food /without food, a bit of a pain but I just had to adjust and make it part of my daily routine. An appointment was made with Hepatology and in the first visit we had a starting date for the new hepatitis C treatment. I was a bit in shock as I thought the first appointment was just to have a chat.

My doctor knew I worked at WASUA and was very informed about the new treatment. My bloods were up-to-date because every time I attend RPH for my HIV I get all my blood counts done. So I didn’t have to wait to have them done again. At that appointment I was given my script to collect on the way out and was ready to go. This was just before Christmas. It was probably best that it was done this way otherwise I would’ve put it off until the next appointment and then the next. So, for the next 12 weeks, just for hepatitis C it was only the one tablet. As I am genotype 1 I was put onto Harvoni. I was happy because it wasn’t too big to swallow. My only side-effect was that at about 2 – 3pm I would get very tired and be ready to go home. Other than that it was smooth sailing. The time went very fast and I only had to have mid-bloods done. The indication from that test was I had cleared hepatitis C. Just another 4 weeks on tablets and then had to have a liver scan done. This is what we had been waiting for, not like the old days when the treatment was harsh. A couple of months later and I have had huge changes in my health and life. • I no longer have hepatitis C • I no longer need to go to RPH re my diabetes

(just my GP) • I have no longer been using drugs • My HIV blood results are the best they have been for about 15 years and show that my viral load is undetectable. That is a lot of changes which I am sure will add some healthier years to my life. My advice is to run, don’t walk. Get onto the hepatitis treatment as soon as you can. We have been talking about this for a long time, waiting for the Government to put it on the PBS. WASUA has a great Nurse Practitioner, called Leanne, who can get you set-up and onto treatment. We will work around all issues that may arise for you and it is all free. We invite you to visit our clinic and talk with Leanne or any of the WASUA staff, about the new treatment. You don’t need to make an appointment or you can give us a call on (08) 9325 8387. My advice would be do it sooner rather than later. Just maybe have a few frozen meals in case you don’t feel like cooking, it won’t matter if the dusting waits another day or two. There are staff at WASUA that have been through the treatment and we are happy to talk about our experiences with you. I can’t recommend it strongly enough. It has made so many changes to my health and is at least one blood-borne virus off my list. Just take the first step… By Dianne Lloyd (Community Development)

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 & 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:God Monday Fridaymeant 10amto-hurt 3pm. knowsto I never you, hurt you hurt you, hurt you,

South West Mobile provides a you, mobile Needle Syringe hurt hurt you Can we start over Exchange Program (NSEP) at the following locations again Can we start baby as friends and times: Give you one more try The tender kisses you give to me Would be the

Margaret River Tues: 3pm-4pm Hospital Carpark only thing I’d ever need God knows Busselton Tues: 5pm-7pm Hospital I never meant to hurt you Carpark I never Harvey Weds: 1pm-2pm Hospital meant to break your heart,Carpark your NSEP (Needle and Syringe Exchange Program) Collie Weds: 3pm-4pm Hospital Carpark heart babe. Free hep A and B vaccinations for hepatitis C positive people Manjimup Thurs: 12pm-1pm Hospital Carpark Free blood testing in a friendly confidential environment Drug treatment support and referral * FREE equipment on exchangeable items Peer education and training * FREE resources and helpful information Street-based outreach Advocacy and support for users A confidential outreach 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 0418 739 372 to arrange a suitable time. HepatitisWA Newsletter // July 2017