#88 • December 2020
Community News
Nobel for Hep C Discovery Plus Hep C Elimination Report and more
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Hepatitis SA provides free information and education on viral hepatitis, and support to people living with viral hepatitis. Street Address: 3 Hackney Road, Hackney Postal Address:
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HEPATITIS SA BOARD Chair Arieta Papadelos Vice Chair Bill Gaston Secretary Sharon Eves Treasurer Michael Larkin Ordinary Members Julio Alejo Catherine Ferguson Bernie McGinnes Sam Raven Kerry Paterson (CEO)
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: Nobel Prize medal (see p2 for more information) 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 Eureka Prize 2 Nobel Prize 4 Hep B Treatment 6 COVID Etiquette 9 Pink Ladies 10 Urine Test for Fibrosis? 11 What’s On? / CNP Info 12 Hep C Elimination 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.
ISSN 2651-9011 (Online)
Eureka Prize for HCV Work Opening treatment up to those who need it
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rofessor Gregory Dore from the Kirby Institute at UNSW Sydney has won the prestigious 2020 Eureka Prize for Infectious Diseases Research. The Australian Museum Eureka Prizes are Australia’s leading science awards. Professor Gregory Dore’s world-leading research on antiviral therapy for hepatitis C virus was recognised on 24 November at the 2020 Australian Museum Eureka Awards, where he was acknowledged for his immense contribution to the health of people who use drugs, through his research that increases access to therapy for hepatitis C.
Direct-acting antiviral therapy for HCV has been highly successful, but the group most impacted by the disease— people who use drugs—has often been neglected by health organisations and governments. Professor Dore has led several clinical trials of direct-acting antiviral therapy evaluation on people who inject drugs. The key benefit of his research is that it has driven equitable provision of the antivirals to this group of people in Australia, which is crucial for HCV elimination efforts. Professor Dore’s research findings have been included in major international HCV management guidelines
and have driven advocacy to enable people who inject drugs to access the antiviral therapy. His research has impacted the attitudes and practices of many clinicians involved in HCV management, evident through increased antiviral treatment in this group. “Australia is an international leader in HCV elimination. The evidence of HCV elimination progress for people who inject drugs and the broader Australian HCV population through a community-centred approach is crucial to driving enhanced investment and strategy development for global HCV elimination,” Professor Dore said. Hepatitis SA congratulates Professor Dore on his welldeserved award. v
Photo of Professor Dore © Richard Freeman/ UNSW
“It is an incredible honour to win this Eureka Prize,” Professor Dore said. “When I established the hepatitis C clinic at St Vincent’s Hospital in 1999, the guidelines at the time required one year of drug abstinence prior to initiating treatment. That denial of the right to healthcare, which was ignored, has driven my research at the Kirby Institute ever since.
of Australia’s hepatitis C affected communities, particularly people who inject drugs.”
“Although this is an individual award, our fabulous team in the Viral Hepatitis Clinical Research Program is what drives the research and makes it so enjoyable. I am also incredibly appreciative for the partnership, support and trust December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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Nobel for Hep C Discovery How the quest for a cure began
Harvey J Alter
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he 2020 Nobel Prize in Physiology or Medicine was awarded to three scientists who have made a decisive contribution to the fight against blood-borne viral hepatitis. Harvey J. Alter, Michael Houghton and Charles M. Rice made seminal discoveries that led to the identification of the previously unknown hepatitis C virus (HCV). Prior to their work, the discovery of the hepatitis A and B viruses had been critical steps forward, but the majority of blood-borne hepatitis cases remained unexplained. The discovery of the hepatitis C virus revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives. The key to successful intervention against infectious diseases is to
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Michael Houghton
Charles M Rice
identify the causative agent. In the 1960s, Baruch Blumberg determined that one form of blood-borne hepatitis was caused by a virus that became known as hepatitis B virus (HBV), and the discovery led to the development of diagnostic tests and an effective vaccine. Blumberg was awarded the Nobel Prize in Physiology or Medicine in 1976 for this discovery.
that hepatitis A was NOT the cause of these unexplained cases.
At that time, Harvey J. Alter at the US National Institutes of Health was studying the occurrence of hepatitis in patients who had received blood transfusions. Although blood tests for the newlydiscovered HBV reduced the number of cases of transfusion-related hepatitis, Alter and colleagues worryingly demonstrated that a large number of cases remained. Tests for hepatitis A infection were also developed around this time, and it became clear
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
It was a great source of concern that a significant number of those receiving blood transfusions developed chronic hepatitis due to an unknown infectious agent. Alter and his colleagues showed that blood from these hepatitis patients could transmit the disease to chimpanzees, the only susceptible host besides humans. Subsequent studies also demonstrated that the unknown infectious agent had the characteristics of a virus. Alter’s methodical investigations had in this way defined a new, distinct form of chronic viral hepatitis. The mysterious illness became known as “non-A, non-B” hepatitis. Proper identification of the novel virus was now a high priority. All the traditional techniques for virus hunting
were put to use but, in spite of this, the virus eluded isolation for over a decade. Michael Houghton, working for the pharmaceutical firm Chiron, undertook the arduous work needed to isolate the genetic sequence of the virus. Houghton and his co-workers created a collection of DNA fragments from nucleic acids found in the blood of an infected chimpanzee. The majority of these fragments came from the genome of the chimpanzee itself, but the researchers predicted that some would be derived from the unknown virus. On the assumption that antibodies against the virus would be present in blood taken from hepatitis patients, the investigators used patient sera to identify cloned viral DNA fragments encoding viral proteins. Following a comprehensive search, one positive clone was found. Further work showed that this clone was derived from a novel RNA virus belonging
to the Flavivirus family and it was named the hepatitis C virus. The presence of antibodies in chronic hepatitis patients strongly implicated this virus as the missing agent. This discovery was decisive, but one essential piece of the puzzle was missing: could the virus alone cause hepatitis? To answer this question the scientists had to investigate if the cloned virus was able to replicate and cause disease. Charles M. Rice, a researcher at Washington University in St. Louis, along with other groups working with RNA viruses, noted a previously uncharacterised region in the end of the HCV genome that they suspected could be important for virus replication. Rice also observed genetic variations in isolated virus samples and hypothesized that some of them might hinder virus replication. Through genetic engineering, Rice generated an RNA variant of HCV that, when
injected into the liver of chimpanzees, showed virus detected in the blood and pathological changes resembling those seen in humans with the chronic disease. This was the final proof that HCV alone could cause the unexplained cases of transfusion-mediated hepatitis. The three Nobel Laureates’ discovery of HCV is a landmark achievement in the ongoing battle against viral diseases. Thanks to their discovery, highly sensitive blood tests for the virus are now available and these have essentially eliminated posttransfusion hepatitis in many parts of the world, greatly improving global health. Their discovery also allowed the rapid development of antiviral drugs directed at hepatitis C. For the first time in history, the disease can now be cured, raising hopes of eradicating HCV from the world population. v
Illustrations © The Nobel Committee for Physiology or Medicine. Portraits: Niklas Elmehed; Diagrams: Mattias Karlén
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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Hepatitis B Treatment Not necessarily a life-long commitment
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here is a common view that once you start hepatitis B treatment, you will be on it for life. This is changing. In recent years, numerous studies have been done looking into the notion of a functional cure for hepatitis B which, when achieved, means therapy can be stopped. What is functional cure? Current hepatitis B treatment cannot completely cure the disease; the aim of current therapy is to suppress the virus sufficiently to prevent liver cirrhosis, liver failure or liver cancer, and thus improve survival. The hepatitis B virus embeds bits of itself in the host cell, allowing it to reactivate and replicate. Current therapy
cannot eradicate this remnant of the virus, which is known as the covalently combined closed DNA (cccDNA). For complete cure to happen, the cccDNA must be eliminated, not merely silenced. The virus also produces other bits of itself in its replication process. Some hepatitis B treatment drugs target various parts of this process, while others seek to enhance the body’s immune system to fight against the virus. A functional cure is a state where the other elements of the virus are eliminated or reduced to the point where the risk of adverse outcomes such as liver failure, is minimal, even though the cccDNA remains. People who have chronic
hepatitis B have various bits of the virus in their blood as a result of the virus replication process. The presence or absence of these bits act as markers for working out which stage the disease is at. One of these bits, known as the hepatitis B surface antigen (HBsAg) is the key marker that a person has chronic hepatitis B. Studies have shown that the level at which it exists in the blood is a good indicator of whether the disease is under control. Generally speaking, the indicators that treatment is working in achieving the goals of maintaining liver health and improving survival are: •
normal ALT levels,
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loss of hepatitis B surface antigen (HBsAg),
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undetectable hepatitis B DNA, and
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the appearance of hepatitis B e-antibodies (antiHBe).
Do these indicators, or end points as they are referred to, really lead to better outcomes for people? According to Prof Lim Seng Gee, Director of Hepatology at the National University of Singapore, meta-analysis
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HEPATITIS SA COMMUNITY NEWS 88 • December 2020
shows significant benefits from the loss of HBsAg: •
72% reduction in liver decompensation,
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70% reduction in liver cancer, and
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78% reduction in liver transplant or death.
These outcomes apply across all sub groups including coinfection, treatment history and race (ethnicity). The idea of looking for functional cure is that when it is achieved, treatment can stop. But why stop treatment at all? There are a few reasons why treatment cessation is being considered, even though the treatment is working to successfully suppress the virus. Long-term therapy presents challenges, including: Risk of developing resistance to the drugs,
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Significant side effects such as bone loss and kidney damage
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Cost of treatment (for the individual if drugs are not subsidised, or for the health system if they are). This factor is an important consideration in countries with limited health resources.
Adherence: for all sorts of individual reasons, sticking to long-term treatment can often be a problem
Accepting that functional cure is something to aim for, there are a range of strategies being looked at to get there. These include •
using current drugs that target the replication process (nucleoside analogues),
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using pegylated interferon (pegIFN),
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using nucleosides and pegIFN in combination or in sequence, or
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stopping nucleoside analogues.
Studies show that while a combination of pegIFN and nucleoside analogues
(NA) produce the best outcomes, with over 6.5% achieving HBsAg loss, and that pegylated interferon clearly outperformed NAs, the overall results of less than 10% indicates that new therapies are needed to achieve functional cure. However, there are exciting possibilities in the strategy of stopping nucleoside analogue treatment. Studies have shown that when those treatments are stopped, there is a rebound of HBV DNA and ALT and this stimulates body’s immune response which then reduces the HBsAg level. The likelihood of HBsAg loss is related to the level of HBsAg at the end of treatment. The lower the HBsAg, the higher the chances of HBsAg loss. With quantitative HBsAg levels of less than 100 IU/mL, the surface antigen loss ranged from 21% to 58.5% (see table, above).
Photo by wayhomestudio [freepik.com]
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For people on hepatitis B treatment, the big concern is whether the virus will reactivate once treatment ceases. Studies have shown that when the immune system is suppressed, the virus will reactivate in
(continued on p16)
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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COVID Etiquette
How to approach the “new normal”
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e all learn how to behave socially, and the rules vary based on our cultural backgrounds. We may shake hands, high-five, hug or air-kiss when greeting others. In some cultures, you never chew with your mouth open, while in others nobody really cares. For some, it’s fine to toss money to the person you’re paying; for others that is extremely offensive. In the current COVID situation, until there are effective vaccines or treatments, the only effective safeguard we have is being careful in how we interact with others: how we greet each other, how we behave in groups, how we project expectations of others’ behaviour, and how we react to unexpected situations. How do you tell others you’re not comfortable in a particular situation. Conversely, how do you tell whether others are uncomfortable? Is it even possible to organise social events such as birthday celebrations, friendly gettogethers and workshops that are enjoyable and positive? This is of great concern to us here at Hepatitis SA. Our client communities, many
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of our staff, volunteers and members, or their families are especially vulnerable to the effects of COVID and other infections. Consider these examples: • Janet attends an education workshop where the presenter uses their laptop as a display. Participants have to crowd around the presenter to view the screen. The workshop lasts for most of a day, with everyone in close proximity. Janet feels uncomfortable, but feels it’s rude to complain. The presenter is not practising good COVID etiquette, but what are the boundaries of courteous behaviour? Would it be rude for Janet to whip out a facemask? Is the onus on Janet to explain why they are doing that? • Brett lives in a region with very low COVID cases. He attends a gettogether with a group of old friends. The gathering is in a restaurant, with every table occupied, and people greeting one other with hugs and handshakes. Service is provided with no physical distancing. There is shared food on the table
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
and lots of high-spirited joking and singing. Brett feels he can’t reject the extended hands and warm greetings, but also feels very uncomfortable and vulnerable. Is it unrealistic to expect everyone to follow the rules? He does not belong to a vulnerable category, but would prefer not to put himself at risk anyway. Is Brett overreacting or being too anxious? Do good COVID manners require us to state our preferences clearly before participating in a social event, or should we not expect others to be relaxed about the rules even if we are? • Kim’s daughter is invited to a birthday party. The invitation says the party would be COVID-safe: outside with only 5 kids. It turns out to be 5 kids plus their parents, and some younger siblings. People are sitting in a small backyard and veranda, less than half a metre apart. There is shared food on a side table, and kids playing normally with lots of physical contact. Kim feels she can’t spoil the party for her daughter and friends by leaving or even by sitting
An earlier version of this piece first appeared on our blog, HepSay, at hepatitissa.asn.au/blog. Come and visit us there!
further away from the other adults. But she has older family members at home who are vulnerable. What can she do without spoiling the fun? In all these cases, there is a genuine risk of COVID spread. Plenty of people have contracted the virus without being aware they were exposed, and gone on to mingle with other people before finding out that they were COVID-positive. Through a mix of good management and good luck, South Australia has so far been relatively unscathed, but there are no guarantees that this will always be the case.
So the big question is: what’s good COVID etiquette? When is it OK to shake hands, hug, and get physically close? Two main approaches suggest themselves. The first is that it is up to individuals to declare their vulnerabilities, such as compromised immune systems, so that others know to follow physical distancing rules with them. The second says that nobody should have to declare their vulnerability because we should automatically act as though everyone is vulnerable, unless special circumstances call for the breaking of that assumption. After all, some people who are at extra risk don’t even know it.
Stay safe
orange badge or ribbon or wristband—to warn other people. As OrangeAware’s founders put it, “If you are at higher risk of contracting or at most risk to the effects of COVID, if you are a frontline worker, have low immunity, are immuno-compromised, if you are elderly and feel at more risk, if you care for or work with anyone who is at special risk to COVID—please wear orange as a gentle reminder to let everyone around you know to take extra care and keep their distancing.”
KEEP DISTANCE
Elbow Bump Greeting This has the advantage of
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
Illustration designed by Freepik
One possible way to manage the first approach is the OrangeAware campaign (see orangeaware.com). For this, people who are unusually vulnerable wear orange—an
simplicity and also doesn’t require those who are vulnerable to have to go out of their way to verbally
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identify their issues in every social interaction. But it also has a couple of obvious disadvantages: most people aren’t going to have heard of OrangeAware or know what the colour signifies, and it requires the vulnerable to single themselves out and draw possibly unwanted attention to themselves. As one person interviewed for this article explained, “I take issue with the OrangeAware approach where the vulnerable person has to declare to the world that they’re vulnerable.”
These drawbacks suggest that the second approach is a better idea. If we act as though everybody is vulnerable, and take appropriate precautions, then it makes every situation safer for everybody. Look at the practice of universal precautions in healthcare: nurses and doctors act to protect
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themselves and others from blood-borne viruses like hepatitis and HIV, as well as other infections, as a matter of course, whether or not the people they are dealing with have told them that they are living with such a condition. Hepatitis SA is a great supporter of the concept of universal precaution, as it both helps remove the need for people to subject themselves to stigma through trying to make other people safe, and lowers everybody’s risk of contracting viral hepatitis and other blood-borne diseases. If we all act as though everyone is vulnerable, nobody needs to volunteer private information about their own lives. Nobody needs to be made to feel uncomfortable or guilty about speaking up in a situation being recklessly managed, whether that’s at work or in their social life. Nobody needs to endanger themselves or their loved ones because of somebody else’s assumptions about what is safe and appropriate. Nobody should be made sick with a life-endangering disease because of peer pressure or embarrassment. SA Health provides advice on COVID safe practices and regular updates. See bit.ly/37sAvjM. Of course, some people are always going to break the
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
rules. But if everybody else is making safe behaviour normal, then the number of risky situations will be dramatically reduced, and the chances of spreading COVID will be minimised. So how can those in charge of organisations and activities be encouraged and supported to make this the normal way of doing things? As always, the answer is likely to be a mix of the carrot and the stick. Governments, employer bodies, companies, unions and community groups need to be unequivocal about what is acceptable, and they need to be supported with resources and funding to make it as easy as possible to make interactions COVIDsafe. But individuals need to be supported too, with clear ways for them to raise issues or make complaints without being punished for it. COVID is likely to be a part of life for some time to come. But we are lucky in that it is a disease that’s dangers can, to a great degree, be minimised by forethought and simple precautions. Let’s work together to make caring for one another’s health an automatic part of how we interact. Do you have a story about a difficult COVID-unsafe situation? Contact us at editor@hepatitissa.asn.au to let us know. v James Morrison
Pink Ladies Event
Education and testing at NMRC
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n collaboration with the Northern Migrant Resource Centre (NMRC) and the Viral Hepatitis Nurses in the North, Hepatitis SA facilitated a project to educate, screen, and provide fibroscans to newly arrived migrant women from Nepal and Bhutan. NMRC warmly welcomed Hepatitis SA to work with the women’s group, and provided invaluable support and assistance throughout the project. A major enabler of the project was the rapport and ongoing communication between NMRC staff and their clients. Every participant received a phone call before each portion of the project, and multilingual staff and volunteers closely assisted with interactions throughout the 2-day project. The first day of the project consisted of a viral hepatitis education session, a delicious catered lunch from Bagster
Road Community Centre, a raffle with gift vouchers up for grabs, and a discussion about day two of the project (the viral hepatitis blood testing and fibroscan clinic, which included a reading of the consent form). Following the education session, the women were able to correctly answer questions about viral hepatitis with ease. Most participants registered their interest to partake in the upcoming clinic and, helpfully, many were prepared with their ID, Medicare Card and doctor’s name. The paperwork was swiftly completed. On the second day of the project, the Viral Hepatitis Nurses for Adelaide’s North, Michelle and Bin, attended NMRC to undertake blood tests and fibroscans. Prior to the clinic, it was found that some participants had already received a blood test within recent years.
While a fibroscan was still undertaken, Bin and an interpreter sat with each of these women to make clear their previous blood result. The rest of the women received both procedures. In the coming weeks, participants will get a letter and a call about their upcoming appointment times to receive their results. To ensure confidentiality, these appointments will occur at the nearby GP Plus Centre. The Viral Hepatitis Nurses will work to ensure each person receives the followup care they require and, depending upon test results, a hepatitis B vaccine clinic may be organised by Hepatitis SA in the near future. We owe a special thanks to Michelle Dieu, Ishwara, Laxman, Dil and Renuka, as well as Bin and Michelle. We look forward to working with you all again! v Shannon
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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Urine Analysis Discovery
The future of fibrosis testing? Photo CC Wikimedia Commons by Durgesh1104
Collagen fibres forming fibrosis in a liver
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ifty protein fragments known as peptides associated with liver fibrosis were found in the urine of patients, according to a new study. The identified peptides could potentially be used in a simple urine test to spot people with the condition, if the research is further validated. Liver fibrosis is frequently caused by viral hepatitis. It is often symptomless in the early stages, until liver function starts to be lost. Patients may then go on to experience cirrhosis, jaundice, ascites (build-up of fluid in the abdomen), variceal gastrointestinal bleeding, and in some cases can progress to cirrhosis and liver cancer. Previous research on biopsies from fibrotic livers has shown evidence of changes of proteins in liver tissue cells. As part of his PhD at the University of Warwick, Dr Ayman Bannaga investigated
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whether these protein changes could also be present in a patient’s urine, and whether they could act as a biomarker of the condition. Dr Bannaga’s research team used a total of 393 urine samples divided into discovery and test sets, representing individuals with various liver diseases and those with no disease present. These were investigated using an advanced technology known as capillary electrophoresis mass spectrometry, that separated out protein components in the urine at a molecular level. Following a two-step validation analysis, the researchers found fifty peptides associated with liver fibrosis in patients, mainly fragments of a protein called collagen (often used by the body for structural purposes in connective tissue). When they tested a new set of patients for these 50 peptides, they correctly
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
identified liver fibrosis patients in 84.2% of cases, and correctly identified those without it in 82.4% of cases. While the results require further validation by other research teams, the researchers hope that their findings could form the basis of a simple and cost-effective urine test that could spot those who have liver fibrosis before it progresses. Dr Bannaga explained that “a urine test is an attractive tool because it is easy to collect from patients, and so this approach can be easily applied in hospitals and GP practices. The ideal potential vision for this test would be to check the condition in people who do not have symptoms to tackle it early, through education, monitoring and medications if needed.” The study can be viewed at bit.ly/2KjtGZS. v
Calming the C 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:
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 5015
•
•
1800 437 222
Calming
Free Fibroscan Clinics
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!
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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Hep C Elimination
Annual report shows worrying drops in testing and treatment
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ewer Australians are seeking testing and treatment for hepatitis C, according to a new report from the Burnet and Kirby Institutes monitoring Australia’s progress in eliminating the disease, Australia’s progress towards hepatitis C elimination Annual Report 2020, released at the end of November. When direct-acting antivirals (DAAs) were added to the Pharmaceutical Benefits Scheme in 2016, the treatment became affordable and accessible, and uptake was high. The decline in testing and treatment during 2019 is a signal for action.
Professor Margaret Hellard AM, Deputy Director at the Burnet Institute, who was one of the authors of the report, said, “The report clearly shows the improved health outcomes DAAs deliver. People are achieving cures after accessing treatment, and they are living free from hepatitis C. Very importantly, fewer people are progressing to the point of needing liver transplants because of hepatitis C. “Now is a pivotal time in the effort to eliminate hepatitis C in Australia. After great success in the first few years that DAAs were available, we are now seeing a decline in hepatitis C testing and treatment uptake. “We need to review, renew and refocus our efforts, engaging with key affected populations to ensure hepatitis C testing and treatment is easily accessible to the people who need it, when they need it, where they need it.” The Kirby Institute’ s Professor Gregory Dore (see p1), who is a co-author on the report, agreed that it is critical to sustain and enhance hepatitis C
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HEPATITIS SA COMMUNITY NEWS 88 • December 2020
elimination efforts. “Australia has done exceptionally well at delivering DAA therapy, and connecting the most atrisk populations with testing and treatment,” he said. “This report brings together data from across the country and gives us a good picture of how we are tracking. The key moving forward will be to use novel testing technologies and innovative screening initiatives to increase diagnosis and linkage to highly curative treatments, whilst also maintaining prevention initiatives such as needle syringe programs.” For the first time, this annual report included information from Australia’s prisons, which showed that an estimated 29% of people treated for hepatitis C in 2019 were treated within the prison system. “Within the prison system, we have an opportunity to use new rapid testing technologies to enhance linkage to care,” said Professor Dore. “With the high prevalence of hepatitis C in prisons, but often relatively short incarceration periods in remand settings, it is vital that we quickly
test and connect people with curative treatments and support.” More than 20 research, clinical, community and government partners across the country provided their data to Burnet and Kirby researchers to produce the report on Australia’s progress towards hepatitis C elimination. Australia’s National Hepatitis C Strategy 2018-2022, a Federal Government strategy, committed to eliminate hepatitis C in alignment with global targets set by the World Health Organization. Setting this goal was made possible with strong political leadership opening up universal access to directacting antiviral (DAA) therapy, backed up by an active community of partners to implement the Strategy. The Burnet Kirby Report
made a number of key findings: • A decline in newly acquired hepatitis C infections was reported by primary healthcare clinics with high caseloads of people who inject drugs and/or identify as gay, bisexual or as men who have sex with men. • Treatment uptake peaked in the months following the listing of DAAs on the Pharmaceutical Benefits Scheme (in March 2016) but has since slowed. • There has been a decline in liver transplants with hepatitis C as the primary diagnosis. • Testing for hepatitis C has declined, particularly testing for hepatitis C RNA to detect new hepatitis C infections.
(continued on p16)
December 2020 • HEPATITIS SA COMMUNITY NEWS 88
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Online Videos
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f you’re looking for some short, sharp, informative and entertaining videos about hepatitis and liver health – we’ve got it covered! Searching our new catalogue for online videos is really easy – hit the ‘search our catalogue’ link on hepatitissa.asn.au/ library and just click on the ‘advanced search option’ …
Then tick the ‘online video’ box in the list of item types…
and click the search button. The catalogue will show you all the videos that you can access online (over 120): have a look down the left hand menu to limit your search for more specific results. The topics list is really useful.
Hep B side Northern Territory AIDS and Hepatitis Council (NTAHC), 2017. Video 4 mins. Short rap animation designed to encourage people to get tested for Hep B and inform those with Hep B that treatment is available for those who need it. bit.ly/hepbside (multiple languages) bit.ly/hepbside2 (English)
What is a FibroScan? Hepatitis Queensland, Brisbane, 2018. Video 1.30 mins. A description and demonstration of a FibroScan: a quick and painless device that is used to determine how healthy your liver is. With special reference to useful application in Aboriginal health care. bit.ly/whatisfibroscan
You’ll find short animations, musical numbers, webcasts, interviews, presentations: something for everyone. Here’s a sample of what we have in the collection…
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HEPATITIS SA COMMUNITY NEWS 88 • December 2020
Fast hep B facts from South Australia’s African communities African Women’s Federation of SA, Hepatitis SA, PEACE Multicultural Services (RASA), Multicultural Youth SA, 2018. Video 2 mins.. Members of South Australia’s African communities came together to create this short educational video specifically for African communities. This video is the culmination of an 18 month hepatitis B community education project by the African Women’s Federation of SA, Hepatitis SA and PEACE Multicultural Services and Multicultural Youth SA. bit.ly/africanfastfacts
Stay safe you mob - get an STI test Dept of Health WA, Perth, 2017. Video 30secs. A frank chat between two mates about the need to have STI checks – adult content warning. bit.ly/stistaysafe
For GPs: treating hep C in 5 steps Hepatitis Queensland, Brisbane, 2020. 3xvideos: 5 mins, 11.31 mins, 12.57 mins. Tips and tools to support GPs in continuing the hepatitis C elimination effort in their practice. Presented by Dr Alison Stewart - Video 1: what are the 5 steps & who to screen in your practice (bit.ly/5stepsvideo1) - Video 2: stepping it through in more detail (bit.ly/5stepsvideo2) - Video 3: Case study (bit.ly/5stepsvideo3)
If tatts could talk (the whole story - getting a safe tattoo or piercing) Hepatitis Australia, Canberra, 2020. Video 1.26 mins. Tattoos can be great fun, but they can also carry bloodborne viruses if not done at a proper tattoo studio. If you go to a professional tattoo or piercing studio in Australia, your chances of getting hep B or C are almost nil. However, backyard tattoos and overseas shops could put you at risk. bit.ly/iftattscouldtalk
Online vein care guide Aust Injecting & Illicit Drug Users’ League (AIVL), Canberra, 2013. Video 50 secs. A short film on how veins collapse from repeated injections (AIVL also has an updated handout which can be found at http://aivl.org.au/ resource/vein-care-guide ) bit.ly/veincareguide
Have you had your blood test for hepatitis B & C? Relationships Australia SA, Adelaide, 2019. Video 2.29mins. Short video (with members of different cultural communities) explaining how common hep B and C are, how it’s contracted, how it affects health - and encouraging people to get tested. bit.ly/bloodtestbc
It’s time for a C change: curing hep C in Australia Hepatitis NSW, Sydney, 2020. Video 3.50mins. Being cured of hepatitis C in Australia is now easier than ever thanks to new cures that have been developed since March 2016. This video introduces what hepatitis C is, how you can get it, the symptoms, as well as the tests and cures available. bit.ly/curinghepc
If you would like more information or assistance searching our catalogue please don’t hesitate to contact us at admin@
hepsa.asn.au.
From ‘Little Hep B Hero’
hepatitissa.asn.au/library December 2020 • HEPATITIS SA COMMUNITY NEWS 88
15
Hep C Elimination
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(continued from p13) • An estimated 29% of people treated in 2019 were treated in prison. • Stigma and discrimination towards people who inject drugs and people living with hepatitis C remains prevalent, raising concerns about how this may be affecting individuals’ access to healthcare. • A need to focus on primary prevention still exists: reported rates of needle
and syringe sharing has remained the same. Prevention efforts need to include improved access to sterile needles and syringes to reduce sharing among people who inject drugs, and expanding health promotion activities. Hepatitis SA supports this through our CNP program (see p11).
in opportunity and uptake needs, which must be addressed. • Modelling in the report highlights that increasing testing, diagnosis and linkage to care is essential for Australia to achieve elimination of hepatitis C, especially by the 2030 target. You can access the full report at bit.ly/368GhYp. v
• Improved access to treatment is needed in rural and remote areas: mapping of treatment uptake in Australia shows inequity
Hep B Treatment
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MENTAL HEALTH SUPPORT
(continued from p5) around 15 % of people with HBsAg loss, with a reactivation rate as high as 72% in some cases. So if you have hepatitis B and have reached a stage where your specialist is advising you to start treatment, bear in mind that this is a changing field. While it may look like you’ll have to be on life-long treatment, that may not be the case as new therapies develop. v Cecilia Lim
Sources Achieving functional cure in hepatitis B – Prof Lim Seng Gee, National University Hospital, Singapore, 2020 Nucleos(t)ide analogues for chronic hepatitis B: Cessation of treatment - Prof Alex Thompson, St Vincent’s Hospital, Melbourne 2016 Slides courtesy of Prof Lim S.G. via Singapore Hepatitis Conference (shc-sg.com)
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COVID-19
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
MENTA
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
COVID-19 ha Anxiety about becoming unwell impacts on th Changes to or loss of work
Difficult financial situations
Our Virtual Support Network is here to help by providing a range of specialist mental health services based in South Australia.
Isolation f
Call 1800 632 753
Changes t
for mental health support by phone and video. Available 8am to 8pm, every day.
Changes t
See all Virtual Support Network services and other helpful resources at:
sahealth.sa.gov.au/ COVID19MentalHealthSupport https://creativecommons.org/licenses © Department for Health and Wellbeing, Government of South Australia. All rights reserved. FIS: 20061.5 Printed May 2020.
Difficult fi
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: Bin - 0401 717 971 bin.chen@sa.gov.au
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
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 2
HEPATITIS SA COMMUNITY NEWS 88 • December 2020
Blood cell image byFreepik/Macrovector
Book your online education session. All you need is internet access.
