Community News
#94 • June 2022
A New Hepatitis?
Plus The Riverland Roadshow 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:
(08) 8362 8443 1800 437 222 (08) 8362 8559
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)
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: James Morrison 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 may have been altered to disguise identifying details of members of the public. This resource was prepared and printed on Kaurna Country
Contents
LIVER CIRRHOSIS
1 A New Hepatitis? 2 Riverland Roadshow 4 Amber Malik Interview 8 Viral Hepatitis Conference Update 11 PROMPt Study 12 Leftover Liver Disease 13 What’s On? / CNP Info 14 In Our Library Patient information booklet 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.
A New Hepatitis?
Children infected by mysterious hepatic symptoms
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n unusual, and probably new, form of hepatitis has appeared in a number of countries this year, first being noticed in the UK, but then spreading to Spain and the Netherlands and on to at least 33 other states and territories.
units, with a number needing liver transplants. The most common symptoms of the mysterious hepatitis are vomiting and jaundice: jaundice is a wellknown symptom of serious hepatitis, as damaged livers
Image by James Morrison
Artist’s Impression The first group of active cases were found in March. Unusually, and alarmingly, all of the known cases have been in children. A number have required transfer to specialist children’s liver
can lead to high levels of bilirubin (a yellowy-orange bile pigment) in the body, which turns the skin and the whites of the eyes a yellow colour. At the time of writing, the Royal Australian College
of General Practice (RACGP) had reported that at least five of the infected children have died.
Not A, B, C, D or E
Lab tests on all of those infected have excluded hepatitis viruses A, B, C, D (where applicable, as D only exists in some people living with hepatitis B) and E. Notably, a number of patients (at least 15%) have had severe COVID-19 infections, but given the overall high rate of infection in the UK generally, it is possible that this could well be coincidence instead of cause. Both COVID-19 and the unknown hepatitis being new viruses developing at around the same time may mean they are linked, or it may be a confusing case of bad luck. Importantly, there is no sign of any link to COVID-19 vaccination: indeed, the majority of affected children are under five years old, and so too young to have received any COVID-19 vaccine. One study found that an adenovirus—a type of common virus that typically causes mild cold- or flulike illness—was present in around two-thirds of the infected UK children.
(continued on p16)
June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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The Riverland Roadshow A Hepatitis C Micro-Elimination Project
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n celebration of World Hepatitis Day 2022, Hepatitis SA—in collaboration with the South Australian Viral Hepatitis Nurses and pharmaceutical compan AbbVie—are undertaking a hepatitis C micro-elimination project in the South Australian Riverland.
commence with training for GPs, Nurses, Pharmacists, and community workers in the area. They will learn about hepatitis C testing, cure, and support services. They will also be informed of our upcoming testing clinics, which they can promote to patients.
It is estimated that there are around 650 remaining people in this region living with hepatitis C*. Testing and treatment could be vital for every one of them.
An important part of the project is preparing the local medical workforce, ensuring Riverland residents have access to healthcare workers with up-to-date knowledge about their health condition.
During the week of World Hepatitis Day (28 July), The Riverland Roadshow will
From Tuesday, 9 August until Friday, 12 August, free community hepatitis C
fingerstick testing clinics will be held at local pharmacies in Barmera, Loxton, Berri and Renmark. To participate, people just need to show up! They can wait for their turn or leave their details and be contacted when the nurse is ready. Blood will be taken via a simple fingerstick test, rather than the usual intravenous blood test. No longer will people have a long anxious wait for their test results. Participants will receive their results via phone on the same day they had their test. Then, those diagnosed with hepatitis C will be followed up by the Viral Hepatitis
Taking a simple fingerprick test for hepatitis C * MacLachlan J.H., Stewart, S. and Cowie, B. (2020). Viral Hepatitis Mapping Project: National Report 2020. Darlinghurst, NSW, Australia: Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine (ASHM), 2020. (www.ashm.org.au/programs/ Viral-Hepatitis-Mapping-Project)
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HEPATITIS SA COMMUNITY NEWS 94 • June 2022
Nurse, who will ensure they are quickly offered the highly effective hepatitis C cure. People living with hepatitis C can be cured within 12 weeks via a course of daily tablets that cause no or minimal side effects. The cure is highly affordable to those with a Medicare card, as they will only pay the pharmacy dispensing fee. Finally, all Riverland residents, whether they get tested or not, will have the chance to enter our competition to win a $500 Pike River Luxury Villas gift voucher. Would you like more information about the Riverland Roadshow? Contact
Hepatitis SA and talk to the Education Team on 1800 437 222 or email education@ hepsa.asn.au, or you can visit Liverbetterlife.org.au. v Shannon Wright
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June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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Global Experience
An interview with Amber Malik
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mber Malik has become the Principal Project Officer - Viral Hepatitis at SA Health, after joining the Communicable Disease Branch in May. She has a fascinating international healthcare background, and was kind enough to talk with us about her personal experiences and her thoughts on hepatitis elimination in Australia. You’ve worked on major health projects in Pakistan, Geneva, and Australia: what’s brought you to focus on viral hepatitis? As a public health professional, I understand that simple modifications in an individual’s behaviours and health practices can prevent the transmission of viral infections. In Pakistan I was managing integrated primary health care projects such as water, sanitation and hygiene (WASH), mother, neonate, and child health care (MNCH), sexual and reproductive health care (SRH), and immunisation. It was complicated, working to eliminate and control communicable diseases in culturally and geographically diverse communities. Working with the UN and Red Cross in Pakistan and Geneva, I was supporting health systems in preventing communicable diseases as per the international
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standards. I supported government health facilities by establishing infection prevention and waste management systems, providing personal protective equipment (PPE), training, waste segregation, and correct disposal of equipment. I was also providing autoclaves for sterilisation and even funding the construction of waste incinerators.
health practices, where basic diagnostic and treatment facilities are available to everyone without any cultural, geographical, or socio-economic disparity. Now that I’ve had the opportunity to observe the best health practices around the world, I believe my knowledge will help eliminate viral hepatitis through various harm reduction strategies.
I was drawn to viral hepatitis, probably for the same reasons that any public health professional would be. The first reason is that, even though hepatitis is considered as the seventh leading cause of deaths worldwide, the epidemic was basically neglected until 2015, the year the global burden of disease figures were released.
What is the level of hepatitis awareness in Pakistan? Is there much government support for education, testing, and treatment?
I believe my specific background gives me an advantage because I have seen both sides of health practices and know how the lack of ownership of health professionals and government badly affects and contributes to the vicious cycle of infection transmission, even when awareness-raising and health promotion activities are being provided at a community level. I have always wanted to work with the world’s best
HEPATITIS SA COMMUNITY NEWS 94 • June 2022
In fact, the primary cause of viral hepatitis spreading so rapidly in the Pakistani population is a lack of education and awareness of the disease, as well as a shortage of medically qualified and scientifically trained health care workers, and an overall lack of health infrastructure. This has resulted in a decreased emphasis on screening, especially in the case of hepatitis C testing, since a person with a hepatitis C infection often appears and feels fine. Blood transfusion is still one of Pakistan’s leading causes of hepatitis C transmission. Even though hepatitis C virus detection is essential in blood screening, it is sometimes limited in
Health monitoring at a mobile medical camp: Punjab Province, Pakistan, 2017
developing countries due to a lack of resources and other technicalities. Despite widespread awareness of disease transmission via blood transfusion, mismanagement and a scarcity of medical facilities contribute significantly to the spread of hepatitis C via blood from infected donors as well as service providers receiving needlestick injuries. Other contributing factors include poor health practices, parental ignorance, and a lack of prenatal and postnatal testing resulting in children being born with HIV and hepatitis C co-infection. Injecting drug use, simple medical procedures being done without adequate PPE, and the improper disposal of syringes and needles due to
inadequate hospital waste management systems all add to the problem. In hospital settings, syringes and needles are usually discarded into general waste and dumped into open pits outside the hospital. These pits are known sources of syringes and needles, and desperate people will go there to collect them. Another more sinister outcome of the inadequate hospital waste management system has been the opening of a black market for ‘cleaned’ used syringes and needles, with facility staff taking used equipment, ‘cleaning it’, and then selling it. Cleaning the syringes and needles is usually only done with water and Dettol, but some—those with a guilty conscience—
will use the hospital’s chlorine stock to disinfect them, proving that they know they are putting people at risk by selling them. These black-market syringes and needles are then purchased by ‘quacks’ to use in their practices and by some people who inject drugs that can afford them and believe these needles and syringes to be safer to use than ones collected directly from the hospital waste pits. And of course, these same syringes and needles are then shared within the purchaser’s circle of friends. What differences have you found in terms of population and country size, in terms of health services and education? Pakistan, for example, has nearly
June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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10 times the population of Australia in around a tenth of the physical space. In Pakistan, blood-borne viral diseases (HCV, HBV, HIV) and sexually transmitted infections share a significant disease burden. Nearly 12 million people are infected with hepatitis B and C, with more than 100,000 new cases reported yearly. Any national response or process has yet to be planned and launched.
Furthermore, in the absence of data collection, analysing the progress of current national interventions is challenging. The most recent surveillance was in 2007! There is an urgent need to collect hepatitis data from across the country. Although the private and non-governmental sectors are contributing, the size of the problem is often overwhelming. The distribution of benefits is
unbalanced between urban and rural areas—rural areas suffer when services are available in urban areas. The health system in Pakistan is divided into primary, secondary, and tertiary levels of care. The lack of diagnostic services at the primary level of care poses a significant burden on hospitals and the patients paying for tests. Most of the population pays for any test from a private laboratory out of pocket, which means they often delay getting tested for a long time. Then there’s the lack of notification of results, often no referrals to a specialist, and a lack of GPs training to initiate immediate treatment after diagnosis or to refer the patient to hospitals where a specialist is available to provide treatment. This all causes delays and not only makes the patient’s physical condition worse, but also leaves them in limbo without any help and education to prevent further transmission within their family and community. What are the challenges of working with blood-borne viruses in SA in the COVID era?
Working at an Afghan refugee camp: Baluchistan , Pakistan
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HEPATITIS SA COMMUNITY NEWS 94 • June 2022
I think the biggest challenge that health services have faced to date has been maintaining services while implementing the required COVID restrictions, such as lockdowns, physical distancing, reducing face-to-face services, and staff shortages due to redeployment, isolating or
Sexual and reproductive health training: Nairobi, Kenya , 2011
being ill. That so many health services have met these challenges and embraced new service delivery methods to continue providing services to their clients in such a short time has been incredible. Now that we are starting to come out of the restrictions era of the pandemic, the next challenge will be getting people back to accessing testing for blood-borne viruses. Since the start of the pandemic, there has been a notable decrease in the number of people accessing testing for these in South Australia. A whole-sector approach will be required to get people at risk of blood-borne viruses to start accessing testing again. Australia has agreed to targets to eliminate hepatitis by 2030. Do you think this is achievable? What do we need to do to make it happen? I feel privileged and at ease living in Australia, one of only a few countries with unrestricted access to direct-acting antiviral (DAA) treatments. Over five years, the Australian Government has provided approximately $1.2 billion to fund DAA treatments so that every Australian living with hepatitis C could receive treatment at a low out-ofpocket cost ($39.50 per month or $6.40 per month for concession holders, and no out-of-pocket costs for Indigenous Australian patients).
I believe that by combining prevention and treatment to combat viral hepatitis, the WHO target of 90% diagnosis and 80% treatment by 2030 is achievable. Prevention is a low-cost method and can reduce the rate of new infections. But it is essential to assess whether the current testing and treatment trend is sufficient to sustain the treatment uptake level required for elimination. I have a few suggestions in mind: 1. Targeted diagnostic and treatment plans for high-risk population groups and high-risk settings may help increase testing and treatment. 2. Point-of-care antibody testing and subsequent RNA testing may reduce the number of patient visits required for a diagnosis in community mental health services, prisons, and opioid substitution therapy clinics.
3. Access to Information and Quality of Care – The patient-doctor relationship is critical, and I believe it would be beneficial to investigate trends in diagnosis and treatment by analysing the prescriptions of different prescribers. 4. Evaluating viral hepatitis-related national and statewide data collection mechanisms may also help assess the current state of data compilation and access mechanisms for seeking expert advice based on data evidence. 5. The use of technology in developing userfriendly mobile applications may be a good option for timely notification, sending testing reminders, and discussing treatment plans with a doctor via the telehealth system. Thank you, Amber! v
June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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Communities, Stigma & Point of Care The 13th Australasian Viral Hepatitis Conference
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he 13th Australasian Viral Hepatitis Conference was held in Brisbane on the last three days of May this year. Key themes throughout included the enormous value of peer work, the vital importance of Aboriginalled viral hepatitis programs, the benefits of Point-of-Care [POC] testing technologies
First Nations
In a demonstration of the importance of Indigenous communities to the future of hepatitis treatment in Australia, Troy Combo, a Program Manager at EC Australia and a proud Bundjalung man, presented on ‘The Road to Hepatitis C Troy Combo’s keynote presentation
and ideas to further enhance their use, and, finally, the ongoing problematic preferential treatment of hepatitis C over hepatitis B.
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elimination in Aboriginal and Torres Strait Islander Communities’. Troy started by congratulating the newly elected Prime Minister
HEPATITIS SA COMMUNITY NEWS 94 • June 2022
of Australia, Anthony Albanese. He commended the Prime Minister on his promising commencement speech which included an Acknowledgement of Country and a commitment to the Uluru Statement of the Heart. Troy then discussed the 2015 launch of the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis 2016-2021, which sets out three key global hepatitis C targets. However, the strategy included only one reference to indigenous communities. Prior to the launch of this global strategy, in 2014 the inaugural World Indigenous Peoples Conference on Viral Hepatitis was held in Alice Springs. This conference allowed delegates to examine the impact of viral hepatitis on Indigenous communities, but also set goals, share innovations and experiences, and build partnerships to address viral hepatitis amongst Indigenous communities. At the second iteration of this conference (held in Anchorage in 2017— see issue 75, online at bit. ly/3OdZxHg), a powerful consensus statement was
developed with three calls to action. The first sought to eliminate avoidable mortality from viral hepatitis amongst Indigenous Peoples and Tribal Communities and reach elimination by 2030; the second to require states and governments to make special provisions in health and funding policies in order to achieve viral hepatitis elimination amongst Indigenous Peoples and Tribal Communities by 2030; and the third to recognise and support the desire of Indigenous Peoples and Tribal Communities to determine their own future and receive culturally effective care. In achieving these goals, Troy explained that countries must follow several key principals, which include an acknowledgement of the diversity amongst Indigenous peoples, the impact of generational trauma, and the importance of Indigenous leadership in achieving these goals. Later in his presentation, Troy discussed national approaches to viral hepatitis amongst Aboriginal and Torres Strait Islander people. He explained that the overall number of Aboriginal and Torres Strait Islander people who live with hepatitis C in Australia is decreasing due to the hepatitis C cure. However, notification rates are increasing, and there is lower uptake of treatment amongst
Aboriginal and Torres Strait Islander people compared to non-Indigenous populations. Regarding future opportunities and requirements, Troy explained that Aboriginal Community Controlled Health Services (ACCHO services) have outstanding processes with diabetes and kidney disease POC testing, which could be replicated with hepatitis C POC testing. Further, he explained that Australia does not have a clear understanding of the extent of viral hepatitis C amongst Aboriginal and Torres Strait Islander populations, and more robust surveillance data is required. Troy saw great opportunities in expanding the role of current data programs from passive data collection to active monitoring and recall systems, and called for rigorous research into Aboriginal drug user networks to increase awareness of patterns of use, injecting behaviours, initiation into use, sites of initiation, and the like.
Hepatitis B Stigma
A striking feature of the conference was the range of stories from people living with hepatitis B. One session featured a video titled ‘The many faces of Hepatitis B’, where five people who live with the virus were interviewed.
The interviews demonstrated their unique and varied experiences and feelings about hepatitis B, but also highlighted issues that should be carefully considered by the viral hepatitis workforce. Overall, a lack of information prior to diagnosis—and the lack of awareness amongst the rest of the community— causes undue harms to people living with hepatitis B. One participant spoke about his experience being diagnosed. He was at school in China, and all the students were tested for HBV as a preliminary step prior to receiving the vaccination. While all his fellow classmates received a vaccination, he was told that he would not be vaccinated because he was living with the virus. He did not know what it meant, but he knew it was not good. He was also informed not to tell anyone else in the class. Another interviewee disclosed he was in a new relationship and frightened to disclose his hepatitis B status to his girlfriend. He had heard her family members discuss hepatitis B in a disparaging manner in the past. When asked to rate the importance of hepatitis B in his life, this participant did not discuss physical health implications. Instead, he discussed the burden on his social and personal life.
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In each person’s narrative, the importance of keeping their
June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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status private emerged. The lack of broader awareness about hepatitis B caused harm to them all.
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Point of Care
Throughout the conference, many presentations discussed the wide-ranging benefits of POC testing technology (see p2 and p11), future opportunities these testing methods may present (including the possibility of providing dried-blood spot tests with Clean Needle Program (CNP) equipment or in syringe vending machines, and providing financial incentives for testing), and the necessity for increased testing in the pursuit of reaching elimination goals. Dr Lise Lafferty from the University of New South Wales and The Kirby Institute presented on her study in which she offered POC testing, clinical assessment and a Fibroscan within a 60-minute window to prison participants. On average, those diagnosed with hepatitis C then received treatment within 6 days of the POC test. During this process, she conducted interviews with 24 participants to gain insight into their experience with the hepatitis C POC testing process. Participants identified prison as an opportune time to receive testing for hepatitis C for various reasons. Some participants felt it was worth undertaking as they had not received a test outside of the prison system (the “might as well” factor), while others felt it gave them peace of mind or
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offered an easy way to protect their family from acquiring the virus upon their release. The POC testing process also provided a more reliable and streamlined service to participants. Some had previously attempted to access testing or treatment but were ultimately hindered by the lengthy process; they were discharged or transferred prior to receiving or completing treatment. Participants also saw the POC testing process as a way to reduce some of the stigma attached to hepatitis C. Through this rapid and efficient testing process, all prisoners could be offered testing on induction to the prison. If all prisoners are offered testing, the process becomes normalised, and no one must identify themselves as a person at risk. Finally, participants felt safer to access hepatitis C testing from the nurses in the prison system, reasoning that these nurses had experience working with atrisk communities and would therefore be less stigmatising and less scandalised. Initially, Dr Lafferty was concerned that testing people during their induction into prison might be too overwhelming. However, participants reported that undertaking the test straight away lessened their burdens. It was sometimes seen as one less thing to worry about. Mim O’Flynn, a Registered Nurse with the hepatitis C Kombi Clinic in Queensland, reported on a POC testing blitz that occurred in Lotus
HEPATITIS SA COMMUNITY NEWS 94 • June 2022
Glen Prison. Whilst Lotus Glen was previously declared free of hepatitis C, over time the numbers once again crept up. Over a 5-day period, and making use of four Gileadfunded GeneXpert POC testing machines, nurses tested 423 men in the prison. In total, 44 participants were living with hepatitis C, and they all received hepatitis C treatment within five days of their test. The prison will now have a GeneXpert machine in their reception area, and test at least 50 new entrants per fortnight. Following her presentation, Mim implored the audience to continue to advocate for CNPs in the prison system. POC testing and the 12-week cure are vastly improving the hepatitis C health outcomes of prisoners, but without harm reduction, reinfections will continue to occur, as they did in Lotus Glen. As Mim explained, “we incarcerate young, healthy people… but they get discharged with a potentially fatal virus. As health professionals, we have to do something! Why can’t we have needle and syringe programs [in prison]? Let’s just do it”. In response, Carrie Fowlie, CEO of Hepatitis Australia, explained there are opportunities to advocate for prison CNPs. She stated that the viral hepatitis sector must reinvigorate this discussion, and come at it from a different perspective— very likely from a legal perspective. v Shannon Wright
POC Study Success
Positive outcome for PROMPt
PROMPt
A
h, l 4
key barrier to hepatitis Participants were offered an 1 1, L. Ralton 1, J. Dawe 2, J.Richmond2, CC. (HCV) treatment is HCV diagnostic test using a Ferguson , E.M. McCartney the process of conventional quick5 fingerstick3antibody 6 1 J. Zobel3, A. Wigg4, V. Cock , E.Y. Tse , T. Rees , D. in Shaw the priority settings of testing that requires multiple (Ab) assay. Participants who behalf ofservices the EC Australia partnership were mental health, prisons and visitson to pathology tested HCV-Ab-positive AOD services. 1 Infectious providers and healthcare then offered a fingerstick Diseases Department, Royal Adelaide Hospital, South Australia, Australia HCV POC testing increased overall rates to obtain an HCV antibody HCV RNA assay run on the 2 Burnet Institute, Victoria, Australia of HCV testing as compared (Ab) test, an HCV RNA test, a GenXpert machine. 3 Gastroenterology & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia to the previous 12 months of diagnosis, and then getting 4 Hepatology Department, Flinders Project staff, including peer Medical Centre, South Australia, Australia standard of care testing. linked5 to appropriate care to educators, Drug and Alcohol Services, South Australia,provided Australia HCV commence treatment. Combined HCV antibody education, andSouth post-test 6 Communicable Disease Control Branch, SApreHealth, Australia, Australia and RNA testing at the point A year ago (see issue 90, at bit. counselling, and linkage to of care has resulted in a ly/3xFCEp6), we covered the care at the time of diagnosis. significant testing scale-up at launch of the PROMPt project, Participants who tested HCV each service. which aimed to overcome RNA positive underwent critical roadblocks to HCV The researchers found post-test counselling, harm treatment by providing high acceptability of POC reduction education and Participant characteristics Total 1549. HCV point-of-care (POC) testing at each service. were linked to treatment. 83% (1,290) male,linkage 17% (256) female, 0.2% (3) other , median age 37 (30-46), Aboriginal/Torres Straitand testing and direct Working with site staff Linkage to care consisted Islander 25% (379) into treatment in the priority local viral hepatitis nurses of site staff being notified settings of mental health, was extremely effective in ofresults the positive HCV RNA N = 1,549. prisons alcohol other Table 1.and HCV Ab andand RNA POC test and RNA positivity facilitating HCV treatment. results, and participant drugs (AOD) services. PROMPt shows that this POC test outcomes Remand Prison Inpatient AoD Inpatient Mental Total details being sent to the approach Health Unit is an excellent PROMPt was run at several local viral hepatitis nurse for way to improve testing1549 rates sites in SA: the Adelaide HCV Ab test (n) 877 and treatment. 496 176 management and ensure people get the Remand Centre, at inpatient % Ab positive 17% (150/877) 19% (96/496) 10% (18/176) 17% (264/1549) The study results treatment and support they alcohol and other HCV RNA test (n) drug 150 96 18 264 demonstrate that it is feasible need if they are living with services, and at a mental % RNA positive 5% (39/877) 2% (10/496) 3% (6/176) 4% (55/1549) to provide HCV POC testing hepatitis C . v health inpatient unit.
Results
RNA positivity
26% (39/150)
10% (10/96)
33% (6/18)
21% (55/264)
Comparison of HCV rates between 12 months of standard Table 2. Comparison oftesting HCV testing rates betweenprevious previous 12 months of standard of careof care HCVtesting testing versus 1212 months of HCV testing HCV versus months ofPOC HCVintervention POC intervention testing Total Population
Total admissions HCV Ab tests HCV Ab positive HCV RNA tests HCV RNA positive %Ab positive RNA positivity Rate of Ab testing (Pi) Difference, (P2 – P1) [95% CI] P-value proportion test/population
Oct 2019 – Dec 2020 (Standard of Care testing) 6259 532 121 141 45 121/532 (22.7%) 45/141 (31.9%) 0.085 (8.5%)
(20.1 – 8.5) = 11.6% [0.104, 0.127] P <0.001
Table 3. Linkage to care outcomes N = 55 Linkage to care Remand Prison RNA positive, n
Oct 2020 – Dec 2021 (POC intervention testing) 7724 1549 264 264 55 262/1549 (16.9%) 55/264 (20.8%) 0.201 (20.1%)
Inpatient AoD Inpatient Mental Total June 2022 • HEPATITIS SA COMMUNITY NEWS 94 Health Unit
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Leftover Liver Disease
Ongoing cirrhosis support
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eftover liver disease continues to affect quality of life for some people despite being cured of hepatitis C.
in their youth. Hepatitis SA too has community members and volunteers in a similar situation.
For them, liver damage from decades of hepatitis C infection cannot be reversed. With the focus on getting everyone treated, some may feel their situation is being overlooked.
Although liver cirrhosis is not curable, with the right support and management it is possible to live well and stay as healthy as possible. Accessible information is crucial not only for the person with liver cirrhosis but also for family members and support persons.
The Haemophilia Foundation Australia (HFA) has achieved micro-elimination of hepatitis C within their community, yet they have members still dealing with liver cirrhosis, the consequence of infection acquired from blood products they received
To this end, Hepatitis SA, with support from HFA, is putting together a collection of information resources for people living with liver cirrhosis.
LIVER CIRRHOSIS
One key resource in this pack is the booklet Liver Cirrhosis – Patient Information Booklet, based primarily on a publication of the same title written by Carlie Stephens, Hepatology Nurse at St George Hospital. Over the years, this booklet has been adapted and tailored for different liver units/clinics at different hospitals.
t
Patient information bookle
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HEPATITIS SA COMMUNITY NEWS 94 • June 2022
This latest Hepatitis SA version includes action plans developed by the Hepatology and Liver Transplant
Unit at the Flinders Medical Centre. The action plans provide a quick reference for emergency situations, as well as tips for maintaining liver health. Liver cirrhosis occurs when liver cells form scars and liver function is impaired as a result. Because the liver plays such a key role in overall health, the implications can be serious. In the later stages of liver cirrhosis— decompensated cirrhosis—you may experience confusion, jaundice, ascites and variceal bleeding. However, with support, regular clinical monitoring, good nutrition and planning, it is possible to stay as healthy as possible and maintain quality of life. Action plans in the booklet include overall tips on staying as healthy as possible, what to do in emergency situations, signs of encephalopathy (mental confusion), understanding your nutritional needs and the best ways to meet those needs. The booklet has been well received by community members during consultation. Liver Cirrhosis – Patient Information Booklet is available online at bit. ly/3MS0UKk. Print versions are available by calling Hepatitis SA on 1800 437 222 or emailing admin@ hepatitissa.asn.au. v
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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 • recently returned from travel overseas. When collecting equipment, we ask that you cooperate with ‘social distancing’ recommendations:
• 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) •
If you can ring ahead, please do so in case any further changes have taken place.
These measures are for YOUR safety as well as ours. Please respect the CNP workers so we can keep this service going!
June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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Mobile Health Apps
Good quality, evidencebased mobile apps can be a convenient way to gain information and control over personal health. Being personalised, trustworthy and confidential they can facilitate individuals to maintain a greater autonomy over a range of matters such as • access to good quality information about health issues, medications, and services • monitoring (and improving) personal health behaviours • improving medication adherence • keeping track of appointments, tests and results. The following free apps are produced by reliable sources and would be a quick and easy way for anyone with an experience of hepatitis to gain knowledge and support in maintaining their health.
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The LiverWELL app LiverWELL, Melbourne. Provides a range of functions for people living with viral hepatitis and other liver conditions: medication and appointment reminders, list and graph test results, record notes and access information, news, events and newsletters. Available in Arabic, Burmese, Chinese, English, Thai and Vietnamese. bit.ly/liverwellapp
Hep B story Menzies School of Health Research, Darwin. A visual, interactive app designed for patients living with chronic hep B and their families. It tells the story of the hep B virus: how you get it, what happens, how you know you have it, and details about immunisation and treatment. Features a separate women’s business section discussing mother to child transmission and ways to prevent it. Produced in conjunction with Aboriginal people in Northern Australia. Available in: English, Yolŋu matha, Kunwinjku, Tiwi, Arrernte, Warlpiri, Pitjantjatjara, Burarra, Anindilyakwa, Murrinhpatha, Gurindji bit.ly/menzieshepbstory
HEPATITIS SA COMMUNITY NEWS 94 • June 2022
MedicineWise app NPS MedicineWise, Sydney. This general medication app can create, store and share medicine lists, dose reminders, information about medications, records of tests and results, healthcare professional details, and other health/condition information. The app can be set up with additional profiles for carers. Allows for linkage to the Medicine Finder and healthdirect apps. bit.ly/medwiseapp
Medsearch Dept of Therapeutic Goods Administration, Canberra. Find, view and save ‘Consumer Medicine Information’ and ‘Product Information’ for prescription medicines, some non-prescription medicines and some of the biological remedies that are included on the Australian Register of Therapeutic Goods. This app can aid in keeping information about medicines in one place and for sharing with family/carers/friends bit.ly/medsearchapp
Smiling Mind Smiling Mind, Melbourne. Practice your daily meditation, mindfulness and sleep exercises from any device. Smiling Mind is developed by psychologists and educators and includes programs for different age groups and settings: personal use, classrooms or workplace. Available in English, Kriol, Ngaanyatjarra and Pitjantjatjara. bit.ly/appsmilingmind
Daybeak app: change your relationship with alcohol Hello Sunday Morning, Sydney. Personalised mobile app that helps you develop healthier habits, whether you want to cut back or quit drinking completely. Recommends tailored activities that are proven to positively change lifestyle habits. Access support and learnings from lived experiences and receive support from ‘care navigators’. bit.ly/daybreakapp
Healthdirect A government funded service providing quality information to assist in making informed decisions about your health: check symptoms, find services, look up medicine information and information on health topics (including hepatitis), and find the best way to get help in an emergency. bit.ly/apphealthdirect
For a full and updated listing go to hepatitissa.asn.au/ library, click on the green ‘search our catalogue’ button and type in ‘app’. Contact us (admin@hepsa.asn.au) if you have any problems with access.
hepatitissa.asn.au/library June 2022 • HEPATITIS SA COMMUNITY NEWS 94
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(continued from p1) In this case it was usually adenovirus 41, which more commonly causes diarrhea in children. A number of the cases which did not show the adenovirus being present were not properly tested, so its presence cannot be ruled out.
Though the first cases were found in March, retrospective testing of children who had shown similar health problems has found cases going back to October 2021. Laboratory testing for additional infections, chemicals and toxins is underway for the identified cases. Dr Renu Bindra, Senior Medical Advisor at the UK
“Our investigations continue to suggest that there is an association with adenovirus infection, but investigations continue to unpick the exact reason for the rise in cases.” The UKHSA, the US Centers for Disease Control and other national health agencies continue to monitor the spread of the infection as they try to learn more about its cause and health effects.
In Australia
In April, Gastroenterological Society of Australia (GESA) paediatric hepatologist Professor, Winita Hardikar, said that although each year in Australia, a small number of children present with unexplained hepatitis, with some requiring a liver transplant, there had not been an unusual spike. In its media statement, GESA said cases of mystery
A 4-year-old child with jaundice.
hepatitis in Australian children “is a rare occurence”, and ongoing surveillance in Australia is occurring. “Practise thorough handwashing, including when supervising children,” the GESA statement advised. “Cover mouth and nose when coughing or sneezing.” It advised parents to be alert to symptoms — which may include nausea, vomiting, abdonimal pain, loss of appetite, fever, jaundice, dark urine and pale faeces — and to contact their doctor if they have any concerns. For more information, contact GESA on gesa@gesa. org.au. v
An earlier version of this piece first appeared on our blog, HepSay, at hepatitissa.asn.au/blog. Come and visit us there!
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HEPATITIS SA COMMUNITY NEWS 94 • June 2022
Image CC Wikimedia
However, since it is very unusual to see hepatitis develop following an adenovirus infection in previously well children, clinical investigations are continuing into other factors which may be contributing, though no other epidemiological risk factors have been identified to date, including recent international travel. Some media outlets claimed research found that cases were linked with exposure to dogs, but the evidence for this is very weak and not well supported.
Health Security Agency (UKHSA), said, “It’s important that parents know the likelihood of their child developing hepatitis is extremely low. However, we continue to remind everyone to be alert to the signs of hepatitis—particularly jaundice, look for a yellow tinge in the whites of the eyes—and contact your doctor if you are concerned.
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 Viral Hepatitis Nurses work with patients in the community, general practice or hospital setting. They are located in the Adelaide metro area but support can also be arranged for people in country areas. They can be contacted directly by patients or their GPs: CENTRAL: QUEEN ELIZABETH HOSPITAL Jeff: 0423 782 415 Debbie: 0401 717 953 Amanda: 0466 851 759 NORTH Bin: 0401 717 971 Michelle: 0413 285 476 SOUTH Rosalie: 0466 777 876 Lucy: 0466 777 873 OFFICE: (08) 8204 6324 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 ONLINE Blood-Safety Education Update your knowledge about blood-safety and viral hepatitis. Sessions include: Overview of hepatitis A, B & C Blood and bodily-fluid safety Best practice after blood exposure Stigma and discrimination Available services FREE = 1.25 HOURS TUESDAY 12 JULY 2022 MONDAY 25 JULY 2022 BOOK VIA:
WWW.TRYBOOKING.COM/BZVHF
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QUESTIONS? EDUCATION@HEPSA.ASN.AU
HEPATITIS SA COMMUNITY NEWS 94 • June 2022
FUNDED BY SA HEALTH, BROUGHT TO YOU BY HEPATITIS SA
