#86 HepSA Community News

Community News

#86 • June 2020

COVID-19 & Hepatitis Update Plus Newborns and Hepatitis C and more

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Hepatitis SA provides free information and education on viral hepatitis, and support to people living with viral hepatitis.

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HEPATITIS SA BOARD Chair Arieta Papadelos Vice Chair Bill Gaston Secretary Deb Perks Treasurer Michael Larkin Ordinary Members Julio Alejo John Beeslee Catherine Ferguson Sharon Jennings Bernie McGinnes Sam Raven Kerry Paterson (CEO)

ISSN 2651-9011 (Online)

Online: www.hepsa.asn.au HepSAY Blog: hepsa.asn.au/blog Library: hepsa.asn.au/library @HepatitisSA

@hep_sa Resources: issuu.com/hepccsa Email: admin@hepatitissa.asn.au Cover: Cover image incorporates ‘Super Nurse’ by FAKE [instagram.com/iamfake, used with permission], in honour of WHO’s International Year of the Nurse and the Midwife, and the COVID-19 pandemic Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email editor@hepatitissa.asn.au.

Editor: James Morrison Some photos in this publication have been altered to disguise identifying details of members of the public.

Contents

1 Newborns & Hep C 2 COVID-19 & Hepatitis 7 Aspirin & Liver Cancer 8 Safer Smoking at CNPs 9 The Future of Hep B Care?

10 HepSA Working Remotely 12 Managing the Achievable 13 What’s On? / CNP Info 14 In Our Library Disclaimer: Views expressed in this newsletter are not necessarily those of Hepatitis SA. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist.

We welcome contributions from Hepatitis SA members and the general public.

SA Health has contributed funds towards this program.

Newborn Resistance Exploring the low rate of HCV infection in newborns

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“The immune system of the [exposed but non-infected] babies shows similar changes

had similar changes in their adaptive immune system, with clear adaptations of the body’s B lymphocytes, the role of which is to produce antibodies able to discover and identify alien microbes, such as viruses, bacteria and parasites.

The study was conducted in collaboration with a maternity hospital in Saint Petersburg, Russia. Of the 55 pregnant women participating, 40 had an active hepatitis C infection, while the others had been cured, but still tested positive for hepatitis C antibodies.

The babies born to women with an active infection were all considered exposed to the virus; despite this, only three of these 40 babies developed hepatitis C.

“A possible explanation is that most babies exposed to the virus in utero manage to deal with it, which we can later see by the B lymphocytes,” said Dr Björkström. “One interesting hypothesis is that these cells can contain novel information that we can use to protect ourselves against hepatises C in the future.”

All the infants were monitored up to the age of 18 months through regular testing, and to increase the volume of comparable data, samples were added from 18 infants who had been infected with hepatitis C at birth.

The study showed that both the babies born with an infection and the babies who had been exposed to the virus by an infected mother

This is particularly important in the quest for a vaccine for hepatitis C. “This is why we need to continue researching,” Dr Björkström said. “We need to understand what it’ll take to obtain lasting protection against the virus. Only then can we attain the WHO goal of elimination.”

Image designed by pch.vector / Freepik

nlike other blood-borne viruses such as HIV and hepatitis B, the risk of a baby being infected with hepatitis C during the mother’s pregnancy or during birth is very low. Only about 5% of babies born to mothers who have hepatitis C are themselves infected by the disease. A possible reason for this low figure is that the baby’s immune system has already destroyed the virus before birth. A new study from researchers at Sweden’s Karolinska Institutet, published in the journal Gut, reveals clear adaptations of the uninfected babies’ immune system that may now lead the way to new treatment methods.

to that in babies infected with hepatitis C,” explained Niklas Björkström, a doctor and researcher at the Institutet.

“This could suggest that the immune cells have encountered the virus in the womb and managed to eliminate it before birth.”

The researchers will now be investigating whether other immune cells in the infants have changed in a similar way. You can see the study at bit.ly/3h5gUtY. v

July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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COVID-19 & Hepatitis

An update

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ll of our lives have been changed by the COVID-19 outbreak. New and important information about the virus emerges on a daily basis, and finding out specific things you need to know can be extremely difficult. Importantly, because COVID-19 is so new, it is difficult to know how it will affect people living with viral hepatitis.

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), a peak body for viral hepatitis research, established the Taskforce on BBVs, Sexual Health and COVID-19

in March. It provides a timely opportunity for the BBV and sexual health sectors to discuss the scientific, clinical, BBV and sexual health service delivery and social implications of COVID-19, and provides consistent and evidence-based messaging to the health workforce, sector partners and community.

In mid-May, the Taskforce presented a webinar on the latest developments in the field. Two highly regarded researchers summarised the current best knowledge about viral hepatitis and COVID-19 in the Australian setting. Professor Benjamin Cowie, an infectious diseases physician and epidemiologist, and the Director of the WHO Collaborating Centre for Viral Hepatitis, talked about hepatitis B, while Professor Gregory Dore is head of the Viral Hepatitis Clinical Research Program at the Kirby Institute, UNSW Sydney, and an infectious diseases physician at St Vincent’s Hospital in Melbourne.

Hepatitis B

“The headline summary is that there is no convincing evidence that people living with hepatitis B have any different risk of acquiring COVID-19 or of having adverse outcomes at a greater incidence than people who do not have hepatitis B, with a couple of notable exceptions,” Ben Cowie explained.

“The most notable of those is people living with cirrhosis are at

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HEPATITIS SA COMMUNITY NEWS

86 • July 2020

“That’s an important thing to reflect on because, clearly, viral hepatitis in general, and I’ll speak about hepatitis B, is one of the leading risk factors for having cirrhosis or severe scarring of the liver in Australia, and that’s really underdiagnosed—a lot of people living with cirrhosis, who acquired that from hepatitis B, haven’t had that diagnosed.”

So is there any preliminary research of interest?

“When you look at some of the best studies from China, where obviously the prevalence of hepatitis B is substantial, looking at the outcomes for people living with hepatitis B, one of the best studies was published in

the New England Journal of Medicine, looking at 1,099 people who had been affected by COVID-19,” Ben Cowie said.

“Of those people, a relatively small proportion were identified with hepatitis B, probably indicating they weren’t being tested or were unaware. And the study found their outcomes have no statistical difference.

In fact, the trend amongst those individuals was that they had less severe disease.

authors actually inverted the proportions of severe and non-severe disease, and therefore claimed that there was evidence that there might be more severe disease, but they had actually read the table wrong! And in fact, the evidence is that there was less severe disease.

However, the numbers are low and so we can’t draw any firm conclusions from that. Other studies suggest that there might be slightly slower viral clearance.”

Image by Hannah A Bullock & Azaibi Tamin

greater risk of adverse outcomes should they acquire COVID-19, and that relates to the degree of cirrhosis or the degree of compensation of their liver disease.

“This was misquoted, sadly in another paper that was published where the

Left: Ben Cowie Right: Greg Dore July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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What about COVID-19 treatment and its effects on people living with hepatitis B? “One of the things to watch significantly in China is that a large proportion of people affected by COVID-19, particularly those who developed more significant respiratory infections, were given steroids, and often quite high doses of corticosteroids, which suppress the immune system. That potentially has significant issues for people living with hepatitis B because a degree of activity of hepatitis B relates to the interplay between viral infection and the immune system controlling that. If people come through with a medication that removes some of the ability of the immune system to keep hepatitis under control, and particularly if they use high doses for prolonged periods, that can cause a significant flare-up of

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hepatitis B. And if someone has unrecognised cirrhosis, or, indeed, recognised cirrhosis, those flares can be potentially lifethreatening. So that’s an important consideration when we think about the therapy for COVID-19 especially, because there’s no good evidence that steroids or any other immune suppression at this juncture has any useful role, and in fact they probably make it worse, which was certainly seen with the original SARS outbreak 17 years ago.”

only around a third of those who should be are on antiviral therapy.

So what do we need to think about when we’re talking about managing the risk of COVID-19 and people living with hepatitis B? “Well, the first thing is we need to be doing better looking after people with hepatitis B in Australia,” Ben Cowie explained. “We know that only a minority of the people living with hepatitis B are having guideline-based care for it. And we also know that

“In Victoria, it’s been asserted that anyone who is affected by COVID-19 can get free testing and treatment in the public health system, irrespective of their Medicare status.

But that’s not always the case. That may not be the case in all jurisdictions.

We’ve certainly seen public health messaging around things like measles outbreaks, be thwarted by

HEPATITIS SA COMMUNITY NEWS 86 • July 2020

“More generally there are social issues. Many people are subject to greater unemployment risk and more severe economic consequences, particularly if they’re part of the casual workforce, and I think that’s something we need to watch. We’ve also published estimates about Medicare access.

For instance, people living with hep B—around 10% of those people—have no access to Medicare.

people going to hospital with measles and then receiving a $10,000 bill for the 3-day stay in hospital, leading to other Medicareineligible individuals avoiding appropriate healthcare because of the threat of economic hardship that results.”

What about the numerous news stories about potential treatments or cures from using medication designed to target other diseases?

“There’s a lot of different media, press releases and pre-print publications all suggesting that there’s some sort of panacea or some exciting new drug around the corner, and even some of the hepatitis B and HIV antivirals have been proposed in that regard.

And I would strongly suggest that appropriate clinical trial-based evidence is essential before we start thinking about advising our patients or our community people affected by hepatitis B to use these drugs for the

purposes of preventing COVID-19. Because we currently have no clinical evidence of any such drug having any effect, and they may well have interactions with the therapies people are on for their existing conditions.”

Hepatitis C

“Before talking about hepatitis C, I’d like to say something regarding COVID-19 generally,” said Greg Dore. “In populationdense settings, like shelters and prisons COVID-19 can spread incredibly rapidly.

So if we think about central surveillance testing of asymptomatic and symptomatic people then I think that’s appropriate to keep the focus on those vulnerable populations as the epidemic moves forward.”

How are people living with hepatitis C likely to be affected? “As Ben said, in terms of the impact of hepatitis or chronic liver

disease on the COVID-19 illness itself, there’s no evidence that hepatitis increases the risk of acquisition, so you’re not more susceptible to acquiring infection if exposed to the virus.

If you have hepatitis C and are yet to develop cirrhosis, there’s no evidence that chronic hepatitis C will lead to adverse outcomes. But people who have advanced liver disease, whether it’s related to hepatitis B or hepatitis C, or alcohol or fatty liver disease, and who have cirrhosis, they are at higher risk of adverse outcomes.”

Why is this? “Partly, I imagine, through the fact that there is a relationship between advanced liver disease and some element of immune suppression,” Greg Dore explained. “So if someone’s liver is being compensated, it’s pretty clear that they would be at higher risk of an adverse

July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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outcome. So it’s important to maintain the focus on people with advanced liver disease.

“But there’s also the context of regular monitoring. People are seeing doctors less now with social distancing.

We have to be very careful that we’re mainting the hepatocellular carcinoma screening, 6-monthly ultrasounds and appropriate review, because that’s one area that could potentially become more fragmented.”

What about Ben Cowie’s comments on therapies for other diseases being used on COVID-19? “Every day there’s a new sort of therapeutic agent being thrown up as a potential agent to be active against COVID-19. I was just reading a report that came out in the last couple of days of a German group that did that sort of mass screening exercise, and listed several hepatitis C protease inhibitors as having potential as antiCOVID-19 active agents.

Being a skeptic, I would put those in the very, very unlikely basket along with most of the things that have been proposed.”

So should people be reconsidering going onto treatment for hepatitis C? “In the setting of whether

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we should move ahead with hepatitis C treatment right now, I think the advice has been very clear, and we’re really keen that people don’t hold back from treatment. We did give some initial advice to them, when you think about the situation in early March, when there were a lot of infections, people were concerned about the interface with healthcare workers and so forth, we did give some advice then about people who are pre-cirrhosis potentially deferring therapy if it was going to be problematic.

I think we would change that advice now to say that everyone should move forward with hepatitis C treatment, and that no one really should hold back.

“In terms of moving forward with therapy, we already know that people do pretty well without monitoring, unless there’s major concerns around treatment adherence. We know, for example, that the SVR assessment can be pushed back. It doesn’t have to be done at 12 weeks post-treatment. So those practical, pragmatic aspects of management can absolutely be implemented in the current environment.

“A very, very strong message would be to

HEPATITIS SA COMMUNITY NEWS 86 • July 2020

convince people to be on DAA therapy. Our message has always been that everyone with active infection should be very much encouraged to continue therapy.”

Finally, what about COVID19’s effect on users of injecting drugs?

“There are some unknowns around what might be happening in the context of injecting drug use in Australia,” Greg Dore said. “I know there’s a lot of anecdotal information around, but my sense is that there haven’t been huge changes in drug use patterns.

People were concerned that there might be a reduction in heroin, so that might then shift people to methamphetamine and other drugs. That doesn’t appear to have happened today. We still haven’t got good information around whether social distancing has had a major impact in terms of injecting practices—that’s even more unsafe injecting in the context of the current environment. And that’s something that we want to look at very closely.

You can see the Taskforce’s latest updates, including this and other webinars, at ashm.org.au/covid-19. v

Aspirin vs Liver Cancer The surprising effectiveness of a well-established medicine

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n a nationwide study of patients with chronic viral hepatitis in Sweden, use of low doses of aspirin was associated with a significantly lower risk of hepatocellular carcinoma (HCC) and lower liverrelated mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding.

The risk of HCC was reduced by 31% compared with no aspirin use, and liver-related mortality dropped by 27%, as long as aspirin use continued.

She noted, however, that this should not immediately lead to changes in clinical practice. A randomised study comparing aspirin

Aspirin, also known as acetylsalicylic acid (ASA), is one of the most widely used medications globally.

It is a generic medication with an extraordinarily low wholesale cost (around 2c or less per dose), so its use for people living with viral hepatitis would be both easy and cheap.

However, as aspirin is contraindicated in chronic and severe liver disease, and can cause side-effects such as upset stomachs, stomach ulcers, stomach bleeding, and worsening asthma, it should not be used without guidance from a GP, Liver Nurse or specialist.

Image designed by Vectorpocket/Freepik

“We were excited to find for the first time in a nationwide Western population that low-dose aspirin use was associated with substantial reduction in risk of developing incident HCC,” lead author Tracey G. Simon, of Massachusetts General Hospital and Harvard Medical School in Boston, told Medscape Medical News.

with a placebo is needed.

And more research is needed in populations with compensated and decompensated cirrhosis to determine the optimal time to make use of aspirin initiation, so as to maximise the benefit and prevent adverse events.

The study, in the March 12 issue of the New England Journal of Medicine, can be found online at nejm. org/doi/full/10.1056/ NEJMoa1912035. v July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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Safer Smoking

Expanding CNPs to protect more people from viral hepatitis

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he clean needle program (CNP) has been a successful harm reduction intervention that has helped reduce the health and social problems associated with injecting drugs. The obvious next step is to look at ways to reduce the harms associated with smoking drugs such as methamphetamines.

Smoking drugs can lead to open sores, burns or cuts on the lips and in the mouth, which can transfer blood to a pipe. If the pipe is shared, even a speck of blood carrying viral hepatitis can transmit the virus. Improvised pipes, made of items such as cans,

light bulbs or syringes, can break easily or even explode when heated, leading to cuts and burns.

Canada and some places in the US have already put strategies into place to reduce the harms associated with smoking drugs. The addition of safer smoking kits in clean needle programs has been successful in reducing blood-borne viruses and other harms. These safer smoking kits include a glass stem pipe, rubber mouth piece, anti-bacterial wipes, gum, condoms and more.

Providing people who smoke drugs with goodquality equipment is cost-

effective, as it is much cheaper to provide the kits than it is to treat people for the medical issues that can result from smoking methamphetamine.

Based on the success that other countries have had this could be a great opportunity for Australian CNPs to expand our range in the drug-using community and reach a wider population group, helping them to protect themselves from viral hepatitis and other blood-borne diseases. v Emily Franklin Emily Franklin is studying Health Sciences at Flinders University

Examples of safer smoking kits from Canada

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HEPATITIS SA COMMUNITY NEWS 86 • July 2020

Improving Hep B Care

Can you help us to improve chronic HBV monitoring and treatment?

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hronic hepatitis B currently has no cure, but there are effective treatment options available to manage the disease.

Unfortunately, 84% of the 14,400 people living with hep B in South Australia are not engaged in recommended monitoring and treatment programs, putting them at risk of disease progression. If left untreated, over time hep B can cause life-threatening liver damage and/or liver cancer. The virus goes through differing phases in the body, and regular monitoring every six months is crucial in determining when treatment is required. If the virus is monitored regularly and the treatment plans are followed, then most people living with hep B can live long, healthy lives.

So why are so many people not receiving correct care?

Chronic hepatitis B is a complex disease, and these complexities require a robust system to ensure people get the care they require, and do not fall through the gaps. GPs must be knowledgeable about

who to test and how to monitor patients. Patients, most often from highprevalence communities where English is not their first language, must receive clear, trusted and culturally appropriate information about hep B monitoring and treatment. Specialists need to be accessible to patients, including those living in regional and remote areas.

How can we improve linkages to healthcare for people living with hep B? A registry database in SA has been proposed as a useful healthcare tool to help expand the capacity of the health system to improve the health of hep B patients.

Such a registry for chronic hepatitis B patients could improve their access to care and ensure lifelong disease monitoring is achievable.

This registry would enable a shared support system for patients consisting of GPs, viral hepatitis nurses and specialist clinicians.

This combined network would strengthen care to all people living with hep B and combat barriers to ongoing care currently faced by patients.

The viability of developing a registry is dependent upon whether people living with hep B would be supportive of it and willing to join. That is why I am developing a survey to determine the acceptability of a registry system for South Australians living with chronic hepatitis B. I want to hear your opinions on a registry and other ideas on how to improve the monitoring and treatment of hep B in South Australia.

I will be inviting people over 18 years old affected by chronic hepatitis B to take the online survey. I am interested in hearing from people who are living with chronic hepatitis B, as well as people directly affected by someone living with chronic hepatitis B. It should take 5-10 minutes to finish and will be completely anonymous. The survey will be open in July 2020. Keep an eye on the Hepatitis SA website for a link to the survey. v Tom Freeman Tom Freeman is a Master of Public Health student at Flinders University

July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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Covering the Distance

How COVID has affected our work at Hepatitis SA

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n February 2020, as the likelihood of the COVID-19 pandemic hitting Australia was increasing, Hepatitis SA started planning. What would our service provision look like, in the event of COVID-19 cases increasing in South Australia and restrictions being put into place. Each team was tasked with brainstorming how the changes would impact on their work, and how each team would adapt to restrictions, which at the time were largely unknown.

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A planning meeting of Hepatitis SA staff was held in early March 2020. Staff who work at the Hackney Office met to discuss what the next 6 months might look like. While much of our work can continue away from the office such as resource development, report writing and future work planning, other services like the Hepatitis Helpline, Clean Needle Program (CNP), as well as workforce and community education, were areas which needed to be thought through.

As the CNP, Admin and IT Support required staff to be in the office, it was agreed to have a roster of skeleton staff attend the Hackney Office to ensure continuation of these programs. We amended the processes in which clients would collect their equipment, ensuring there was a 1.5m distance between the client and staff member (see p13), as well as additional cleaning of surfaces.

As is usually the case, the phones would be answered by staff onsite and any Helpline calls would now be transferred to the coordinator of Hepatitis SA Helpline & Support Services, who would be working from home.

Our IT and communications system had to be “pivoted” to accommodate staff working from home. Take-home equipment had to be prepared for people who needed them and registers set up to track them. The question of internal staff communication was discussed and software to substitute face to face interaction was trialled and set up.

While the education team very nimbly adopted an easyto-setup software so they could continue delivering their sessions (more on that later), a Google account was set up for staff to share files remotely. Meanwhile, work began on setting up an integrated organisationwide communication and file

Hepatitis SA staff and their executive assistants during a Zoom meeting

HEPATITIS SA COMMUNITY NEWS 86 • July 2020

sharing system that could also be used for video meetings.

Organising our magazine mailout was a challenge as key staff members were working from home. In a great show of support, staff from all program areas volunteered to help. The Information and Resources team reorganised the process, printing out mailing labels at home and delivering them to the office. On-site workers took delivery of the magazines from the printer and sorted them into manageable lots, which other workers took home to pack and label before returning them to the office for posting. Amazingly, the remotely organised and socially distanced mailout was completed in the same time as our old-style mailouts.

The biggest challenge the organisation faced was our regular internal meetings and our workforce and community education. Previously several staff had used various video conferencing platforms for meetings, but no one had hosted a meeting, so how the various platforms worked from a host point of view were unknown.

The process of delivering an education session via Zoom was an interesting one at first. Some groups of participants did not have their cameras on, so it felt like talking to yourself for an hour or so. But as our confidence grew, we were able to get some interaction from the participants through the chat function in the program. The education team intend to continue using Zoom as an educational platform moving forward.

fun component of Zoom meetings has been the addition of the family pet as meeting members. Hearing a dog bark in the background as the post is delivered, or a cat climbing across the computer when someone is talking has definitely made for some interesting times.

The Hepatitis SA team have loved meeting each other’s pets, even if it has been over a computer screen.

All in all, we have all learnt to adapt to the changes the restrictions imposed, and we plan to continue to expand the remote working methods we have developed so as to complement our regular activities when they resume.

If you or your team would like to organise an education session via Zoom, please contact our office on 83628443 or education@ hepsa.asn.au. See the back cover of the magazine for more details. v

Jenny Grant

It wasn’t only the Education Team who began using Zoom, other Hepatitis SA teams started using it as a way to stay connected and virtually see each other while working from home. Hepatitis SA has also been using Zoom for our internal staff meetings, as well as participating in larger network meetings across the sector. A notable

July 2020 • HEPATITIS SA COMMUNITY NEWS 86

Illustrations by stories/Freepik

The Education Team got straight onto testing a variety of platforms to see which would be the most userfriendly from an educational perspective. After a few failed attempts and many laughs, it was decided that Zoom would

be the best choice of platform to learn in the short space of time available to us. Our Zoom account was set up and the promotion of our new way to educate South Australians was sent far and wide.

Initially we were sceptical as to whether people would take up the offer of education via an online platform, but after a few days the requests started to come in from metropolitan organisations, and also services in rural and remote areas were making contact.

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Managing the Achievable Get the hepatitis C cure today

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f you haven’t achieved some great new thing while in isolation, there is something wrong with you. At least that’s what some social media influencers would have us believe.

Motivational posts—urging you to learn a new language, start a new business or become a walking encyclopaedia—label you as lacking discipline if you achieved none of those grand goals.

Truth is, if you are anything like me, you’d have been struggling to bother to even get dressed each day.

Isolation at home has not been “free time” in any normal sense. There is a deadly global pandemic and it is OK not to be OK with this. People are dealing with job losses, reduced incomes and fears about the illness for self or loved ones.

Even if we are among the lucky ones to retain our jobs, we may find difficulty focusing, with additional demands at home such as a houseful of children to keep occupied. These are strange and uncertain times.

It is also time for selfcompassion. Kindness to oneself is not practised enough, in my opinion. We are our own worst critic; cruel and unforgiving to ourselves.

We often fail to understand that we need to put ourselves first, particularly during this time of uncertainty, so that we are there for others who need us. The oft-cited example to support the rationale of self-care is oxygen masks on airplanes.

The flight attendant instructs you to “put your oxygen mask on first,” before helping others. Why is this an important rule for ensuring survival? Because if you run out of oxygen yourself, you can’t help anyone else with their oxygen mask.

We are in a challenging situation right now. For most of us, all sense of normality has been turned upside-down and there seem to be very few things within our control— unless you are living with chronic hepatitis C. Really? Yes, really.

Getting cured of hepatitis C is one of the easy things you can do to improve your

The sort of Tweet you can safely ignore

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HEPATITIS SA COMMUNITY NEWS 86 • July 2020

health and make your life less stressful. It is one thing you can control during this time.

With hepatitis C your health is compromised, and you may be fearful that symptoms of COVID-19 may be worse for you.

While this novel coronavirus is still proving a challenge for medical researchers, they have got that other virus— the hepatitis C virus—in hand. New treatments are available that cure hepatitis C quickly and with few side effects, and with more than a 95% success rate.

Curing your hep C will reduce fatigue, brain fog and feelings of depression, and help you be the best version of yourself for others, or even just for you. For most people, this cure can be achieved with pills, taken over 8 or 12 weeks.

In South Australia, we are so lucky; with very little effort you can contact your local viral hepatitis nurse and, with their support, rid yourself of your hep C. So, be kind to yourself. Just pick up that phone and give one of those friendly viral hepatitis nurses a call (see inside back page for contact numbers). With so much done by telephone these days, you might only need one face-to-face appointment, and there’s a chance you may only need to get dressed once… v Lisa Carter

Calming the C

Calming

Free Fibroscan Clinics •

E NEED FOR • Information and support in a confidential, TH D N A 9 -1 ID V CO O T DUE friendly environment CALMING THE LL A , G N CI N TA IS D L SOCIA • Speak to others who have had SPENDED SUtreatment BEENwelcome E friends HAV SSIONS • Partners, family and C SE OTICE: UNTIL FURTHER N 7 222 Please ring 1800 43 ation for hepatitis inform

Hutt Street Day Centre: 258 Hutt St, Adelaide SA 5000; call Margery on 0423 782 415 to make an appointment • Information and support friendly environment • WestCare Services: 11/19 19 DVI CO TO E DU • Speak to others Millers Ct, Adelaide SA 5000;who hav R 415 FO Partners, and frien call on ED 0423 family 782 THE• NE DMargery AN , to make an appointment NG SOCIAL DISTANCI •

Now meeting at HACKNEY, ELIZABETH and PORT ADELAIDE Call Us! For information, phone 8362 8443 Free, confidential information See over for dates and support on viral hepatitis:

5015

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1800 437 222

CLINIC Wonggangga L LIVERTurtpandi AL Aboriginal Primary Health SESSIONS HAVE Care Service (Pt Adelaide meeting ENDEDat HACKN SP SU EN1Now st BE CNP); Wednesday of each and PORT ADE L FURTHE month, amR , 11 UNTI9.30–11.30 ChurchNO St, For Port Adelaide SA : TICE information, phon ring See over for

e Pleas Anglicare Elizabeth Mission; 7 22 18001443 17 April, Aug, 132Nov, 9.30am –12 pmpa , 91-93 titisElizabeth he for Way Elizabeth (Bookings via mation for in reception in person, or call 8209 5400) Noarlunga GP Plus; fortnightly, Alexander Kelly Dr, Noarlunga Centre SA 5168 (Bookings via Noarlunga CNP

A Note to Our CNP Clients We are approaching the COVID-19 pandemic with an abundance of caution in line with the recommendations of health experts.

We ask that you arrange for someone else to collect your equipment, if you have • any flu-like symptoms such as fever and cough, or

• We will place equipment on a table for you to pick up: this will maintain social distancing • We will fill out the data sheet

• We recommend that you collect a month’s supply of equipment (in case of any upcoming closures or supply delays)

• recently returned from travel overseas.

• If you can ring ahead, please do so in case any further changes have taken place.

When collecting equipment, we ask that you cooperate with ‘social distancing’ recommendations:

These measures are for YOUR safety as well as ours. Please respect the CNP workers so we can keep this service going!

July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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COVID-19 resources, all in one place T

he unprecedented events over the last months have seen an explosion of information about COVID-19 and many important resources that relate to hepatitis and other liver issues. It’s quite difficult to keep track of new information being made available on an almost daily basis … but don’t worry—we’ve got it covered!

From bit.ly/3deCfP4

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Our library catalogues the most credible and useful of these resources on a weekly basis, so they’re all stored in one place, easy to find and easy to access.

We’ve prioritised those produced in Australia but also collect the most relevant materials published internationally.

The complete collection can be found by searching the catalogue (the green link is at the top of the library home page at hepatitissa.asn.au/ library)—just type in the words: COVID (or

Coronavirus) and you’ll see the whole list. Check the sub-topics at the left hand side of the page and you can refine your results to suit your purpose, e.g: • for a specific population group, • produced in multiple languages, • relating to treatment issues, or • educational/awareness materials.

We send out updates on the most recent reports, videos, online training sessions, factsheets and

From ncphn.org.au/coronavirus-information#mob

HEPATITIS SA COMMUNITY NEWS 86 • July 2020

From www.afao.org.au/our-work/coronavirus-covid-19

websites via our email alert system (contact us if you would like to add your contact details), and make them available from our library home page (hepatitissa.asn.au/ library).

We’re really happy to hear from organisations that are producing new resources

too. We have stringent criteria for inclusion so that end users can be sure of a reliable and useful product, but we’re happy to be contacted about any new resources that could be included. Send any suggestions to admin@ hepsa.asn.au. v Joy Sims

From bit.ly/2M6mqOr

From bit.ly/2zvksop

From ‘Little Hep B Hero’

hepatitissa.asn.au/library July 2020 • HEPATITIS SA COMMUNITY NEWS 86

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COVID-19

MENTAL HEALTH SUPPORT COVID-19 has had a range of mental health impacts on the community through:

Isolation from loved ones and usual supports Changes to normal daily routines Changes to or loss of work Difficult financial situations Anxiety about becoming unwell Our Virtual Support Network is here to help by providing a range of specialist mental health services based in South Australia.

Call 1800 632 753

for mental health support by phone and video.

Available 8am to 8pm, every day.

See all Virtual Support Network services and other helpful resources at:

sahealth.sa.gov.au/ COVID19MentalHealthSupport https://creativecommons.org/licenses Š Department for Health and Wellbeing, Government of South Australia.

All rights reserved. FIS: 20061.5 Printed May 2020.

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HEPATITIS SA COMMUNITY NEWS 86 • July 2020

Useful Services & Contacts Hepatitis SA Free education sessions, printed information, telephone information and support, referrals, clean needle program and library.

(08) 8362 8443 admin@hepatitissa.asn.au www.hepsa.asn.au Hepatitis SA Helpline 1800 437 222 (cost of a local call) Adelaide Dental Hospital A specially funded clinic provides priority dental care for people with hepatitis C with a Health Care Card.

Call Hepatitis SA on 1800 437 222 for a referral. beyondblue Mental health information line

Hutt St Centre Showers, laundry facilities, visiting health professionals, recreation activities, education and training, legal aid and assistance services provided to the homeless.

Nunkuwarrin Yunti An Aboriginal-controlled, citybased health service, which also runs a clean needle program.

258 Hutt St, Adelaide SA 5000 (08) 8418 2500

PEACE Multicultural Services HIV and hepatitis education and support for people from nonEnglish speaking backgrounds.

Lifeline National, 24-hour telephone counselling service.

13 11 14 (cost of a local call) www.lifeline.org.au Mental Health Crisis Service 24 hour information and crisis line available to all rural, remote and metropolitan callers.

13 14 65

1300 224 636 www.beyondblue.org.au

MOSAIC Counselling Service For anyone whose life is affected by hepatitis and/or HIV.

Clean Needle Programs in SA For locations visit the Hepatitis SA Hackney office or call the Alcohol and Drug Information Service.

(08) 8223 4566

1300 131 340 Community Access & Services SA Alcohol and drug education; clean needle program for the Vietnamese and other communities.

(08) 8447 8821 headspace Mental health issues are common.

Find information, support and help at your local headspace centre 1800 650 890 www.headspace.org.au

(08) 8406 1600

(08) 8245 8100 Sex Industry Network Promotes the health, rights and wellbeing of sex workers.

(08) 8351 7626 SAMESH South Australia Mobilisation + Empowerment for Sexual Health www.samesh.org.au Youth Health Service Free, confidential health service for youth aged 12 to 25.

Youth Helpline: 1300 13 17 19 Parent Helpline: 1300 364 100

Viral Hepatitis Community Nurses Care and assistance, education, streamlined referrals, patient support, work-up for HCV treatment, monitoring and follow-ups. Clients can self-refer. Contact nurses directly for an appointment.

Central: Margery - 0423 782 415 margery.milner@sa.gov.au

Debbie - 0401 717 953

North: Lucy - 0401 717 971

Michelle - 0413 285 476

South: Rosalie - 0466 777 876 rosalie.altus@sa.gov.au

Jeff - 0466 777 873

Specialist Treatment Clinics Subsidised treatment for hepatitis B and C are provided by specialists at the major hospitals. You will need a referral from your GP. However, you can call the hospitals and speak to the nurses to get information about treatment and what you need for your referral.

• Flinders Medical Centre Gastroenterology & Hepatology Unit: call 8204 6324 • Queen Elizabeth Hospital: call 8222 6000 and ask to speak a viral hepatitis nurse • Royal Adelaide Hospital Viral Hepatitis Unit: call Anton on 0401 125 361 or 8222 2081 • Lyell McEwin Hospital: call Michelle on 0413 285 476 or Lucy on 0401 717 971

Free Blood Safety + Viral Hepatitis Professional Development via

Book your online education session.

All you need is internet access.

Sessions cover: ¤ Blood and bodily fluid safety ¤ An overview of hepatitis A, B and C ¤ Transmission risks/myths (including issues like needle-stick injury) ¤ Testing and treatments ¤ Best practice after blood exposure ¤ Standard precautions ¤ Stigma and discrimination ¤ Disclosure ¤ Available Services Cost: Free Duration: 1 hour How to book: Contact education@hepsa.asn.au with your preferred date/time (we will then send you instructions, and a link, to access Zoom) 2

HEPATITIS SA COMMUNITY NEWS 86 • July 2020