#92 HepSA Community News

#92 • January 2022

Community News

Missing Targets

Plus Rapid Hep C Testing and more

FREE!

Please take one

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

Postal Address: Kaurna Country PO Box 782 Kent Town 5071 Phone:

Fax:

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: derived from an image designed by @kenshinstock/ Freepik Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email editor@hepatitissa.asn.au.

(08) 8362 8443 1800 437 222

Editor: James Morrison

(08) 8362 8559

This resource was prepared and printed on Kaurna Country

HEPATITIS SA BOARD Chair Arieta Papadelos Vice Chair Bill Gaston Secretary Sharon Eves Treasurer Michael Larkin Ordinary Members Julio Alejo Catherine Ferguson Kate Kelly Bernie McGinnes Sam Raven Kerry Paterson (CEO)

Some photos in this publication may have been altered to disguise identifying details of members of the public.

Contents

1 GP & Nurse Education 2 Rapid Hep C Testing 4 Hep B Targets 7 Hep C Targets 10 Hep Elimination in Indigenous Australia 13 W hat’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.

ISSN 2651-9011 (Online)

Viral Hepatitis & STI Screening

GP and Nurse Education Event O

n 11 November 2021, Hepatitis SA hosted a GP and Nurse Event to provide education on screening for viral hepatitis and sexually transmissible infections (STIs). The event was held at The Cathedral Hotel in North Adelaide, and was kindly sponsored by biopharmaceutical company AbbVie. The idea for the event came from discussions with a viral hepatitis nurse who suggested that if we could increase screening for viral hepatitis, then the nurses would be able to take care of the rest.

Further discussions resulted in including STIs as a bit more of a drawcard for clinicians.

Presenters on the night included Dr Carole Khaw (Senior Consultant at the Adelaide Sexual Health Centre), Jeff Stewart (Viral Hepatitis Nurse Consultant for Central Adelaide Local Health Network based at Port Adelaide), Dean Harris (Positive Speaker at Hepatitis SA) and Jenny Grant (Education Coordinator at Hepatitis SA).

Dr Carole Khaw presented information on symptoms, screening and treatment for chlamydia, gonorrhea, mycoplasma genitalium, syphilis and HIV. Jeff Stewart presented information on

Dr Carole Khaw presenting on the evening symptoms, screening and treatment for hepatitis B and hepatitis C. Jenny interviewed Dean on his personal experience of having lived with hepatitis C, and the consequences of his late diagnosis of the virus.

Despite the inclement weather on the evening, the event was well attended, with 19 GPs and nurses joining the session.

Evaluations conducted at the end of the evening showed all participants had improved their understanding of STI screening and a majority of participants had improved their understanding of viral hepatitis screening.

Those who did not have an improved understanding worked in health centers within prisons and indicated that this was already part and parcel of their work.

Some of the participants’ comments on the session were: • “Very informative, great venue, friendly attendees, superb speakers.”

• “Thank you for your efforts.”

• “Thank you for an informative evening: +++great!”

• “Very, very informative.”

• “Very grateful to Dean for his very heartfelt and honest sharing of his experiences.

Very valuable insights.

Thank you, Dean.”

A huge thank-you to the Cathedral Hotel, who did an amazing job of getting food and drinks to the table with minimal disruption. The food was delicious, and the staff were very friendly.

Also, thanks to Kristy from AbbVie for being so supportive of the idea of holding this event. We hope to hold more in the future to increase the screening of at-risk populations for viral hepatitis and sexually transmissible infections.

For more information on the event, or if you would like to organise something for your clinic or workplace, please contact Jenny 83628443 or jenny@hepsa.asn.au. v Jenny Grant Education Coordinator

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

1

Rapid Results

HCV Rapid Testing Clinics using the GeneXpert Machine

C

ommencing in October 2020, the Hepatitis SA HCV Peer Information and Support Workers have been assisting with testing for hepatitis C in the community using rapid testing.

Our first experience with rapid testing was involvement in the PROMPt research study, whereby our Peers provide support to the Clinical Nurses at the Adelaide Remand Centre, DASSA Inpatient Withdrawal Services, Glenside Rural and Remote Ward and, more recently, at Hutt Street Day Services for people experiencing homelessness.

Since November 2021 the Viral Hepatitis Nurses have also had access to a portable GeneXpert machine.

SA Health has acquired the GeneXpert machine to help increase testing rates for hepatitis C, in order to reach the Australian Government’s goal to eliminate hepatitis C as a public health threat by 2030.

This method of testing is conducted with just a fingerstick blood test and provides a result in less than

2

an hour! This means that traditional blood samples taken by needle and syringe are not required to diagnose a person’s hepatitis C status, making it easier to test people with difficult veinous access or for those who have a chaotic lifestyle which puts hepatitis C testing low on their list of priorities.

GeneXpert testing for hepatitis C is TGA-approved and will identify whether someone has a current hepatitis C infection that requires treatment. It takes about 10 minutes to provide pre-testing information and take a sample. We then call the participants about an hour later with their results, and to also arrange followup testing or treatment, as required.

Hepatitis C is preventable, treatable, and curable, with just a course of daily tablets for 8 or 12 weeks.

It is critically important to diagnose and treat hepatitis C early to avoid the risk of serious liver disease, including liver failure, cirrhosis, liver cancer and further transmission.

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

This manner of testing is extremely portable. All we require to conduct the testing is a private room with a desk or table, two chairs and a powerpoint to plug the machine in. The GeneXpert machine is a cube approximately 40cm wide (see opposite page), and has the capacity to run four samples at a time. As each sample completes (after an hour), a new sample can be put in for testing. The samples can be kept in the cartridges for up to four hours before running the tests, but the contents must not be disturbed, or the test will fail. This meant that what we did on the Viral Hepatitis Nurses’ first day of having access to the machine, is likely a world first!

The Viral Hepatitis Nurses had a patient referred to them for hepatitis C testing.

The person was bedridden and awaiting surgery. The nurses had been informed that the surgeon would not do the surgery without a hepatitis C RNA test (this may or may not have been true).

It was explained to me that various nurses had attended

her home more than once to collect blood by the usual needle and syringe method for testing. This was not successful for several reasons, including patient resistance and difficult veinous access.

Knowing that if we could just retrieve a fingerstick sample of blood from this patient—we transported the sample, holding on to it like a human shock absorber in the car along the way, and ever so carefully from the car back to the office where the machine was—we might just get the result required. We did this ever so tentatively, knowing that the sample is vulnerable and will not run without errors if the temperature of the cartridge is over 28°C or is shaken even slightly. You may wonder why we didn’t take the machine to the person? As it happened, we would not have had anywhere to plug the machine in, and would have then had to stay a full hour in this person’s home, which was less than an ideal setting for this activity. The great news is that we let the sample settle for a while and then started the test. To our surprise we were able to give

our client, and the referring surgeon, the result that day!

It was good news for all.

This was a highly unusual circumstance (and will not be offered as standard procedure), but it really highlights the wonderful benefit of a fingerstick test over traditional testing.

In the short time since we began using the mobile GeneXpert and fingerstick method of testing, the benefits have been highlighted again and again!

We have attended OST pharmacies and Community Corrections sites with the machine, and found people that had been lost to followup—not because they’d been avoiding treatment, but because it just keeps getting put to the bottom of their list of priorities.

Another person said to me that they thought they had been at risk of hepatitis C transmission when they commenced injecting, before being in control of their own sterile equipment and mix, but they would never disclose to a GP that they had been at risk of contracting

hepatitis C for fear of being treated differently. They were extremely grateful and relieved to be informed, in just one hour from test to result, that they did not require treatment.

We have met others along the way that have avoided their post-treatment test due to the difficulty of getting a sample from their veins, and some who have told us that they thought they had been reexposed but were told that the treatment was so expensive that they only get “one shot” at it. It is very rewarding to be able to be a part of putting their minds at ease and informing them that we are so lucky in Australia that anyone who needs treatment is able to access it and be cured!

The fingerstick test for hepatitis C will be available in 2022 in a variety of locations, including regular days at the Adelaide Remand Centre and the Hutt St Day Centre. Call us on 8362 8443 for details or check our website for notices.. v Lisa Carter Peer Information and Support Coordinator

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

3

Hep B Targets Slipping

Australia 23 years behind on care, 24 on treatment

A

ustralia still has a long way to go to achieve its National Hepatitis B Strategy targets aimed at eliminating the disease by 2030.

The latest report from the Doherty Institute’s Viral Hepatitis Mapping Project reports that while overall infant immunisation reached the national target of 95% by 2020, coverage was low among Aboriginal and Torres Strait Islander children.

Overall treatment uptake for chronic hepatitis B (CHB) is only half the 2020 target of 20% and for chronic hepatitis B care (i.e. treatment or monitoring), is less than half the targeted 50%.

Nation-wide, uptake of treatment and care in both hepatitis B declined in 2020.

This was not an unexpected result in light of the COVID-19 pandemic. Regions which saw the greatest

4

declines in treatment uptake were Central and Eastern Sydney, Hunter New England and Central Coast, Country SA, and Western Sydney.

Regions where monitoring uptake reduced the most were Murrumbidgee, South Eastern Melbourne, Eastern Melbourne and North Western Melbourne.

Northern Territory At the launch of the 2020 Viral Hepatitis Mapping Report this week, the Northern Territory was identified as an example the rest of the country could study.

Uptake of hepatitis B treatment and care in the Northern Territory (NT) made huge strides between 2016 and 2020. Hepatitis B treatment uptake rose from less than half the national average in 2016 to just below

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

the national average in 2020, and the Northern Territory’s hepatitis B care uptake at 24.8% is above the national average (22.6%).

According to the report’s lead author, Dr Jennifer MacLachlan, as well as other participants at the launch, this achievement was the result of long-term planning and effort, and working with people on the ground to find solutions that are culturally friendly and accessible for communities.

Encouragingly, ten of Australia’s 324 Statistical Areas 3s* have already reached the 2022 treatment target of 20% and three have reached the national target of 50% care uptake. (See charts on p5.) * Australian Bureau of Statistics data collection areas. See Data by region | Australian Bureau of Statistics (abs.gov.au)

2020 HEPATITIS B TREATMENT UPTAKE: TOP REGIONS

2020 HEPATITIS B CARE UPTAKE: TOP REGIONS

According to the Report, Australia’s National Hepatitis B Strategy (2018–2022) targets include: •

80% of people living with CHB diagnosed

•

50% of people living with CHB engaged in care

•

20% of people living with CHB receiving treatment.

Overall, an estimated 8.6% of the Australian population live with chronic hepatitis B. Rates by regions vary, ranging from 1.84% of the population in the Northern Territory to 0.28% in Tasmania. Other regions of higher prevalence include South Western Sydney (1.33%), Central and Eastern Sydney (1.33%), Western Sydney (1.25%) and North Western Melbourne (1.23%).

The prevalence rate in Adelaide is 0.74% and in Country South Australia 0.42%.

Testing South Australia

South Australia ranks fifth (8.8%) in hepatitis B treatment uptake and seventh (16.7%) in care uptake out of the eight states and territories. The Adelaide Primary Health Network (PHN) had a treatment uptake of 9.9% with Charles

Sturt, Port Adelaide – West, Burnside, Marion and Salisbury among the highest in the PHN. (See chart below).

Despite this, in a number of these higher-uptake areas, the number of people starting treatment dropped during 2020, in contrast to previous years where new treatment uptakes were increasing.

Testing for hepatitis B fell by 15% in 2020 in contrast to increases in previous years. Reductions were most marked in New South Wales and Victoria. Data from Victoria showed that of all people recommended for hepatitis B testing, less than 30% had a record of having gone for a test.

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

» 5

»

PROJECTED PROGRESS

Furthermore, it would appear that testing was lowest among people from ethnic backgrounds that were associated with higher prevalence. There was also not enough testing among those with a diagnosis of liver disease and at greater risk of developing serious disease.

Years Behind

In 2020 in Australia, an estimated 222,559 people were living with chronic hepatitis B. Of these, more than a quarter (27%) were not diagnosed and 77.4% were not in care. In other words, over 60,000 people in Australia living with hepatitis B did not know they

have it, and over 172,000 people living with hepatitis B were not in care, be it regular monitoring or treatment.

This is encapsulated in the “Cascade of Care” diagram below.

It has been estimated that up to 30% of people with chronic hepatitis B may need antiviral treatment†. Without clinical management, hepatitis B can lead to serious liver disease including liver cancer and liver failure.

While not everyone who has hepatitis B needs to † Viral Hepatitis Mapping Project: National Report 2018–19 – National Surveillance for Hepatitis B Indicators 2019, p 22.

2020 CHRONIC HEPATITIS B CASCADE OF CARE IN AUSTRALIA

receive anti-viral treatment, to ensure that all those who need treatment do get it at the right time, everyone living with hepatitis B need to be monitored regularly.

Australia is currently a year behind target on diagnosis, 23 years behind on care and 24 years behind on treatment. In this time of daily updates on COVID infection numbers and vaccination targets, this report is a timely reminder that there are other diseases which need attention and where targets need to be met if we are to reduce loss of lives and the burden on the health system.

About the Mapping Project The Viral Hepatitis Mapping Project looks at geographic variations in the prevalence of viral hepatitis as well as access to care, to identify priority areas for response.

The 2020 report comprises the Seventh National Hepatitis B Mapping Report and the Fourth National Hepatitis C Mapping Report.

The Viral Hepatitis Mapping Project is undertaken by the WHO Collaborating Centre for Viral Hepatitis. v

Cecilia Lim

Hep C Targets in Trouble Australia likely to miss hepatitis C targets

D

espite having been one of the leading countries in the global campaign to eliminate viral hepatitis, Australia may now not meet its 2022 national hepatitis C treatment target or the 2030 global target.

and 2020, close to 88,800 people received hepatitis C treatment. This brought the number of people with chronic hepatitis C to just over 122,260 at the end of 2019, including new diagnoses.

The proportion of people with hepatitis C taking up treatment has dropped steadily since the initial surge in 2016. Although close to half of Australians living with hepatitis C have been treated since, we will not meet our national target of having 65% treated by 2022 if the decline continues. Nor will we meet the 2030 global target of treating 80% of people with hepatitis C.

South Australia, which has the lowest hepatitis C

prevalence (0.51%) at the start of 2016, is also the state with the highest rate of treatment uptake (58%). The highest hepatitis C prevalence (1.54%) among the eight states and territories is in the Northern Territory, which also has the lowest treatment uptake (21.6%).

CHC treatment in Australia, by month, March 2016–December 2020

These were key findings from the Viral Hepatitis Mapping Project National Report 2020.

At the start of 2016, there were close to 189,000 people living with hepatitis C in Australia. Between 2016

» January 2022 • HEPATITIS SA COMMUNITY NEWS 92

7

»

Estimated prevalence of CHC, by state and territory, start of 2016 and resultant restrictions.

As expected, this was more pronounced in those regions where cases of COVID-19 were most concentrated, such as NSW and Vic,” the Report said.

The Report said in order to reach the National Strategy target of 65% uptake by 2022, an additional 34,000 people would need to be treated.

This translates to 17,000 more people being treated a year—double the number that received treatment in 2020.

In other words, treatment numbers need to increase dramatically in order to meet the 2022 target.

If the current reduction in treatment uptake is not reversed, modelling shows that Australia will not reach the 2022 target of 65% treatment. Neither would any individual state or territory, although South Australia would be close (64.5%) under a scenario which assumes a minimum decline in treatment uptake.

uptake in 2016 indicates a trend, not a pandemicinduced blip.

There was, however, a bigger drop in treatment rate in 2020, exacerbating the problem, especially in rural and regional areas.

“Despite national trends remaining relatively stable, some PHNs experienced a significantly greater decline in hepatitis C treatment uptake during 2020 than they had during previous years, suggesting an effect on treatment uptake from the COVID-19 pandemic

Non-metropolitan areas have less access to specialist services and more people who are socially and economically disadvantaged.

This mix of factors makes it harder to identify the key reason for lower treatment rates in some PHNs. Reasons

Hepatitis C Treatment Uptake by Remoteness 2016–2020

The Challenges

Although it would have been convenient to blame the COVID-19 pandemic for the decline in treatment rate, the decline in treatment rate which began almost immediately after the high

8

Numerically there are more people with chronic hepatitis C in urban areas but the rate of infection is in fact higher in rural and regional areas, and the rate of treatment uptake lower. The seven Primary Health Network (PHN) areas with the lowest treatment uptake, all had above average prevalence and were predominantly outside metropolitan areas.

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

most likely vary between regions and communities.

For instance, screening and testing people in rural and remote Aboriginal communities can be particularly challenging.

Aboriginal Health Council of South Australia STIBBV Program Coordinator, Josh Riessen, pointed out that the tasks of identifying and referring at-risk clients are more challenging for rural health workers. Information they need to assess if a client is at risk may not be readily at hand, and there are no friendly GPs or nurses in the neighbourhood to whom they can refer their clients. On top of this, the worker needs to attend to all of the client’s other health issues.

Other hard-to-reach groups include people on the

fringe. At the recent Second National Viral Hepatitis Elimination forum, Professor Greg Dore from the Kirby Institute said that not all of the undiagnosed people living with hepatitis C are in the mainstream. “There is still a sizeable proportion of the high-risk population who are not treated,” he said. “These are people at the edges, people who are not currently injecting and so not accessing services, vulnerable people without housing… transient populations.”

Next Steps

Australia’s early success in tackling hepatitis C will lag further if we don’t find ways to change the current downward trend in treatment uptake.

Observed uptake and projected future CHC treatment trends, based on 3-yearly change trends, 2016–2030

Suggestions from Professor Dore include re-framing how we think about our success or the lack of it. “We should be looking at other things, such as better surveillance of new infections, so we can identify the prevalence of active infection in priority population groups,” he said.

“Tracking this could help us break the back of this epidemic.”

Other forum participants at the Viral Hepatitis Elimination forum suggested actively adopting programs or pilots that work so that they become standard practice rather than a novelty, and working at community levels to achieve micro elimination.

Scaling up prescribing by General Practitioners (GPs) and other non-specialist providers is possibly another way to increase access to treatment, especially in rural and regional areas. According to the Report, PHNs with a higher proportion of GP prescribing saw less significant declines in treatment uptake during the pandemic.

None of these actions by themselves would fix the downward trend. What’s needed is a coordinated strategy that pulls effective solutions together into a concerted effort, and adequate funding to implement the strategy. v Cecilia Lim

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

9

Indigenous Australians & Hepatitis Elimination D

ecember saw the launch of the Progress Towards Hepatitis C Elimination Among Aboriginal And Torres Strait Islander People In Australia report. This is the first report to provide a measure of progress of

hepatitis C elimination among Aboriginal and Torres Strait Islander people in Australia. Unrestricted access to government-subsidised direct-acting antiviral (DAA) therapy for hepatitis C has seen some encouraging

impacts, including large numbers of people being treated and some declines in hepatitis C-related liver failure and mortality.

However, findings highlight a number of gaps, particularly in overall treatment uptake and harm reduction, and worries about new hepatitis C infections, of particular concern among young Aboriginal and Torres Strait Islander men.

Lifetime history for hepatitis C testing is relatively high among Aboriginal and Torres Strait Islander people, and comparable to that among non-Indigenous people.

But research has found that recent (in the previous 12 months) hepatitis C RNA testing among Aboriginal and Torres Strait Islander people who inject drugs remains suboptimal. Regular hepatitis C testing is pivotal to ensure timely diagnosis and linkage to treatment.

Although treatment uptake among Aboriginal and Torres Strait people has improved considerably since the availability of DAA therapy, it too remains suboptimal, and is consistently lower than among non-Indigenous people. This has been corroborated by findings from a range of studies

(continued on p12)

10

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

»

Recommendations

The report made a number of important recommendations.

1: Aboriginal Community Controlled Health Services (ACCHS) should be supported to expand harm reduction services, including needle and syringe programs, where appropriate. Well-planned approaches and ACCHS workforce education should be developed to facilitate successful implementation.

2: Access to harm reduction, including needle and syringe programs, should be expanded in prison settings. This requires political will and support and justice system workforce education.

3: Targeted cultural education of needle and syringe program workforce should be developed and implemented to address high occurrence of needle and syringe sharing among Aboriginal and Torres Strait Islander clients.

4: Targeted healthcare provider education to address the daily experiences of Aboriginal and Torres Strait Islander people with racism, stigma and discrimination, and feelings of shame, particularly around injection drug use and hepatitis C. 5: Opportunistic hepatitis C testing and treatment should be offered to clients attending opioid agonist therapy clinics or attending general practitioner clinics and ACCHS for other reasons.

6: Education of GPs regarding hepatitis C testing which is currently included as part of the regular health checks should be implemented and expanded.

7: Electronic medical record reminders should be implemented to prompt hepatitis C testing in clients with elevated liver enzymes, other indicators of chronic liver disease, or risk factors for hepatitis C acquisition (such as a history of injection drug use and incarceration)

8: Point-of-care hepatitis C antibody and RNA testing for people at risk of hepatitis C should be implemented in a variety of settings, including ACCHS, needle and syringe programs, drug treatment clinics, prisons, mental health services, homelessness services, and mobile clinics.

9: Directly observed hepatitis C treatment should be offered with daily opioid agonist therapy to clients attending a variety of settings, including opioid agonist therapy clinics, pharmacies, and general practitioner clinics. A “one-stop shop” approach incorporating point of care hepatitis C testing and same day treatment initiation should be implemented for high-risk clients.

10: A best-practice approach, holistic healthcare addressing other comorbidities, social and cultural determinants of health should be provided by a multidisciplinary team. Diverse, flexible culturally, gender and age appropriate models of care should be implemented including mobile (outreach) services.

11: Expand peer worker workforce into ACCHS sector and other GP services to support clients with testing and treatment as well as education, where appropriate.

12: Further analyses should be conducted to determine the occurrence of testing and treatment by jurisdiction, and service type.

13: Further analyses of data gaps should be undertaken, including enhancing data collection of Aboriginal and Torres Strait Islander identity in surveillance projects.

14: Facilitate involvement of Aboriginal and Torres Strait Islander leadership in all aspects of the hepatitis C response, including policy, research, clinical care, and prevention service areas.

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

11

»

(continued from p10) around the country where treatment uptake has ranged between 30% to 52% in the period 2016-2020.

Encouragingly, cure rates were high (94-95%) among Aboriginal and Torres Strait Islander people who received treatment and had a posttreatment test available, and comparable to those among non-Indigenous people. In other good news, reinfection rates remained low (1-2%).

The report also found that among Aboriginal and Torres Strait Islander people who inject drugs, highrisk injecting behaviour (such as needle-sharing) is consistently higher than among non-Indigenous population. In addition, the social injustice that means Aboriginal and Torres Strait Islander people account for 27% of the Australian incarcerated population exposes them to more injecting drug harm.

Culturally, age- and genderappropriate harm reduction and treatment services in community and custodial settings are sadly lacking.

A major finding of significant concern is the trend in new hepatitis C infections among younger (15-39 years of age) Aboriginal and Torres Strait Islander people. New hepatitis C notification rates among these younger Aboriginal and Torres Strait Islander people have increased between 2010 and

12

2019, while rates among non-Indigenous people in the same age groups are decreasing. New hepatitis C notification rates have been consistently higher than those among non-Indigenous population since 2010.

In 2020, the new hepatitis C notification rate among Aboriginal and Torres Strait Islander people in the 15-24 age group was almost 10 times the same age group among non-Indigenous people.

Similarly, the new hepatitis C notification rate among Aboriginal and Torres Strait Islander people in the 25-39 age-group was 7 times that in the same age group among non-Indigenous people.

Further, findings demonstrate that new hepatitis C infection rates are consistently higher among Aboriginal and Torres Strait Islander men than Aboriginal and Torres Strait Islander women with rates 3.6 times as high among men aged 15–24 compared to women in this age group (386 vs 107 per 100,000 population) and twice as high among men aged 25–39 compared to women (470 vs 218 per 100,000 population).

Young Aboriginal and Torres Strait Islander people face barriers to accessing age appropriate and same-sex health professionals and peer workers across the healthcare workforce which may impede level of engagement with health services. Also,

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

services in rural and remote communities are infrequent or inadequate.

Notably, findings demonstrate that almost all current hepatitis C diagnoses are among people with a history of injecting drug use, and over three-quarters are among people with a history of incarceration.

While it is reassuring to see hepatitis C is not prevalent in the broader Aboriginal and Torres Strait Islander community, urgent strategies are needed to significantly improve harm reduction and treatment access among Aboriginal and Torres Strait Islander people who inject drugs and who have been incarcerated.

Finally, evidence from the NSW studies demonstrate that the increase in hepatitis C treatment uptake has led to reductions in incidence of hepatitis C-related liver failure (decompensated cirrhosis) and mortality.

However, a higher proportion of Aboriginal and Torres Strait Islander people with an end-stage liver disease diagnosis, and who have died, had a history of alcohol use disorder compared with the proportion of nonIndigenous people the same conditions, suggesting that alcohol use disorder is a key risk factor for progressive liver disease in the setting of highly curative hepatitis C treatment. v

Call Us!

Free, confidential information and support on viral hepatitis:

1800 437 222 Don’t like Talking?

No Problem.

Visit hepsa.asn.au - no need to log in, lots of info & updates Follow the HepSAY blog - hepsa.asn.au/blog Order print resources - hepsa.asn.au/orders/ Follow us on Twi er @hep_sa or Facebook @Hepa sSA

ALL services & resources FREE

Free Fibroscan Clinics •

Hutt Street Day Centre: 258 Hutt St, Adelaide SA 5000; call Margery on 0423 782 415 to make an appointment

•

WestCare Services: 11/19

195000; COVID-SA E TO DU Millers Ct, Adelaide R 415 FO call on ED 0423 782 THE NE DMargery AN make an ST appointment ANCING, AL DI SOtoCI CLINIC • AL Wonggangga L LIVERTurtpandi Aboriginal Primary Health HAVE SESSIONS Care Service (Pt Adelaide SPENDED EN1stSU BE CNP); Wednesday of each L FURTHE month, amR , 11 UNTI9.30–11.30 ChurchNO St, Port Adelaide SA : TICE 5015

•

•

ring

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 information 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!

January 2022 • HEPATITIS SA COMMUNITY NEWS 92

13

Hep & Health Info

Quick reads

Feeling like you have a case of information overload? Probably very common in recent times: there’s so much to absorb given the daily health related updates that we try to keep up with.

If you’re looking for some brief and easy to read information about testing, treatment or how to protect your health: here are some resources that should answer your questions.

Cleaning up body fluid spills (blood, urine, saliva, faeces, etc) Hepatitis SA, Adelaide, 2021. 3 posters How to safely handle blood spills, sharps and other contaminated objects, and where to get help in South Australia. bit.ly/3pErf58

Hepatitis B in pregnancy World Hepatitis Alliance, 2020.

1p. poster.

Information about testing and vaccination (for baby and birth parent) as well as breast feeding. Webpage contains translate tool for multiple languages. bit.ly/3oAWHlh

Antibody positive and PCR undetected means no hep C Hepatitis SA, Adelaide, 2020. 3 fold brochure A negative PCR test means you do not have hepatitis C even if you have a positive antibody test. Printed copies of this resource are available from Hepatitis SA; just email admin@hepsa.asn.au bit.ly/3IKvfdd

14

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

Testing and treating hepatitis C - information for patients Hepatitis Australia, Canberra, 2020. 3p. infographic.

Charts the process through testing, diagnosis, treatment and appropriate follow up.

Versions available for GPs and for patients. Available in Arabic, Chinese, English, Hindi and Vietnamese. bit.ly/3ybjk2R

5 questions to ask your doctor or healthcare provider NPS MedicineWise, Sydney, 2019. 1p.

5 questions to make sure you end up with the right tests, treatments and procedures - not too much and not too little. Available in multiple languages as poster, wallet card or factsheet. bit.ly/3ELcqnO Hep B and C: busting the myths LiverWELL (Hepatitis Victoria), Melbourne, 2019. Double sided graphic/factsheet.

This simple, colourful poster explains clearly some of the myths around hepatitis B and C - and clarifies the facts around transmission, symptoms, testing and treatment. bit.ly/3Iz5Z9n

The latest hep C treatments Hepatitis SA, Adelaide, 2019. 1p infographic.

Contains the 4 latest treatments (Epclusa, Harvoni, Maviret and Zepatier) approved by the PBS for treatment in Australia. Read online only: for free print version, call 1800 437 222 or email admin@hepsa.asn.au. bit.ly/3pIhJOi

Hep B fast facts poster Hepatitis SA, Adelaide, 2016.

4p. brochure A set of Infographics on basics of hepatitis B designed for South East Asian communities.

View only online. Free up-todate printed copies available from admin@hepsa.asn.au.

Chinese, English Hindi and Vietnamese versions also available. bit.ly/3y8HXNE

As always: if you have any problems accessing any of these resources please contact us at admin@hepsa.asn.au. Hope you all stay safe and healthy!

hepatitissa.asn.au/library January 2022 • HEPATITIS SA COMMUNITY NEWS 92

15

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 16

HEPATITIS SA COMMUNITY NEWS 92 • January 2022

Blood cell image byFreepik/Macrovector

Book your online education session.

All you need is internet access.

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: Jeff - 0423 782 415

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

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 • Lyell McEwin Hospital: call Michelle on 0413 285 476 or Bin on 0401 717 971

FREE rapid rapid testing testing for for hep hepCC Just Just aa fingerstick fingerstick sample sample waiting,we’ll we’llcall callyou youwith withyour yourresult) result) Results Resultsin in 11 hour hour (no waiting,

Wed, Wed,99March March2022 2022 Thurs, Thurs,10 10March March2022 2022 & & Fri, Fri,1111March March2022 2022 9am–11am 9am–11am

Brad Brad Jackson Jackson Pharmacy Pharmacy 2/217-219 2/217-219 Main Main North Rd, Rd, Sefton SeftonPark Park Talk Talk to to Lisa, Jeff or or Deb Deb for foran aneasy easytest test and and easy cure cure with withjust justpills pills

2

SA SAHealth Healthhas hascontributed contributed funds towards towardsthis thisprogram. program.

HEPATITIS SA COMMUNITY NEWS 92 • January 2022