#96 HepSA Community News

Postal Address: Kaurna Country PO Box 782 Kent Town 5071

Cover: Image by 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

Phone: (08) 8362 8443 1800 437 222 Fax: (08) 8362 8559 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

Research Boost Kirby Institute awarded $3.28M for infectious disease research

The Commonwealth Department of Health has awarded a combined $3.28 million towards two Kirby Institute-led projects as part of the government’s Blood Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Research Program.

$1.63 million was awarded to the REal world Assessment of people living with Chronic Hepatitis B in Australia (REACH-B) Study, which is being led by Professor Gail Matthews, Head of the Kirby Institute’s Therapeutic and Vaccine Research Program. The study will be a longitudinal cohort study of people living with chronic hepatitis B virus (HBV) infection. By following up with people living with HBV over a long period of time, the study aims to better understand the HBV disease spectrum in Australia, assess treatment eligibility and uptake among people living with HBV, and to evaluate novel methods to enhance linkage to care and treatment adherence.

“Hepatitis B is a chronic condition that affects the liver, but can be managed with antivirals,” said Professor Matthews. “Whilst

new infections with hepatitis B are reduced thanks to a national hepatitis B vaccination program, many people living with hepatitis B in Australia remain undiagnosed and not linked into care. It’s important that we have a comprehensive understanding of the demographics who are impacted by hepatitis B, so that appropriate testing, treatment and care can be delivered to those who need it.”

boost clinic attendance, and comprehensive STI and BBV testing within routine health check.

A $1.65 million grant was awarded to a project evaluating community-led models of delivering annual Aboriginal and Torres Strait Islander Health Checks, and aims to embed STI and BBV testing in those checks. It is being co-led by the Kirby Institute’s Mr Robert Monaghan and Dr Skye McGregor. While there are some gaps in the delivery of STI and blood borne virus testing for Aboriginal and Torres Strait Islander people, Aboriginal communitycontrolled health services are using innovative strategies to

“We are excited to be working with Aboriginal community-controlled health services to evaluate culturally acceptable incentivised programs to engage people in annual health assessments, and the embedding of STI and BBV testing in the health assessments,” said Robert Monaghan. “Regular testing is a cornerstone of the public health response to minimising the impacts of infectious diseases, so community-led models will encourage more people to get tested in a way that is comfortable for them.”

The Commonwealth Blood Borne Viruses (BBV) and Sexually Transmissible Infections (STI) Research Program funds eligible organisations to undertake innovative blood-borne virus and STI research that enhances the evidence base supporting STI and BBV health policy and practice, and improving health outcomes for people living with or at risk of bloodborne viruses and STIs in Australia.  v

On 26 October 2022, Hepatitis Australia hosted Australia’s Biggest Quiz. The event, part of our World Hepatitis Day celebrations, was an impressive attempt to break the Guinness World Record for largest online quiz attendance, while also raising awareness about the cure for hepatitis C.

Taking place simultaneously online and at live venues throughout Australia, Australia’s Biggest Quiz was hosted by well-known media

Tony Barber, as well as our own liver mascot, O’Liver.

The event included 25 quiz questions, many of which were presented by Australian television, music, and

sporting

personalities like Dr Karl from Neighbours, Ranger Stacey, Johnathan Thurston, Shannon Noll, and the woman who voices Siri on Apple phones.

The South Australian live event was held at Eureka Tavern in Salisbury, watching a live link to the main hub in Blacktown, New South Wales, and was headed by expert quiz master David Murrin. In a satisfying effort against 16 venues in other states, Salisbury commenced the quiz at the bottom of the tally, and gradually climbed the scoreboard to end up in fifth position.

To usurp the current record holders, the quiz required 2,329 participants. While over 2,500 people across Australia took part, technical glitches prevented a number of participants from answering all questions—a requirement for the official record attempt. Therefore (for now!) the record remains with Camden Council and their Corporate Challenge.

During the quiz itself and its pre-promotion, the message that hepatitis C can be cured was disseminated far and wide across Australia. Furthermore, it was clear that in-person attendees confidently answered the final quiz questions about the hepatitis C cure. Congratulations on the positive outcomes and on the hearty effort, Hepatitis Australia! v

Online Options New national community and clinical trial resources

Vitalvoicesonhepc.org

is Australia’s first dedicated website presenting carefully researched personal stories of hepatitis C, treatment and life after cure.

The website has two aims. First, it aims to support people living with hepatitis C in thinking about and/or having treatment. Second, it aims to inform the public about hepatitis C and what can be done about it.

Vital Voices sheds light on the stories of people affected by hepatitis C, using original audio, re-enacted video and text clips to present people’s experiences in their own words.

What is hepatitis C? How does it feel to be diagnosed with it? What is it like to have treatment and be cured? In addressing these questions, Vital Voices

aims to inform public discussions of hepatitis C, to counter stigmatising misconceptions, and to promote understanding of living with the virus and its treatment. If you are living with or supporting someone living with hepatitis C, there will be stories here which reflect your experience, and which Vital Voices hope can help guide you through the many difficulties and puzzles of the experience.

Drawing on in-depth qualitative interviews, the website presents detailed accounts of hepatitis C, treatment and cure. Also presented are key themes found in the interviews: Planned and designed with the help of a national advisory panel, Vital Voices aims to showcase the lives of people affected by hepatitis C, emphasising their significance, complexity and vitality.

I think the biggest [reason I had treatment would have been when my eldest son and his wife got pregnant with their child. I didn’t want to take any chances, so I spoke to the 1800 number for the Hepatitis line. My niece had hep C too, and just talking to my sister about the antibodies and stuff like that, I worked it all out. I made copies of my blood tests and my liver scans, so that I can compare them or have a look at the different results.

From Carol’s Story, on Vital Voices

Hepatitis

B Voices

Australia is a new organisation which looks to empower and support people living with hepatitis B at hepbvoices.au.

Doherty Institute researchers and co-founders have launched the first hepatitis B community organisation wholly led by people with lived experience of hepatitis B in Australia, Hepatitis B Voices Australia. Hepatitis B often trails behind hepatitis

ClinTrial Refer is a new website that has partnered with the Gastroenterological Society of Australia (GESA) to make clinical trials easier to access for people with hepatitis B and hepatitis C

ClinTrial Refer is an online search tool that displays all GESA clinical trials, as well as other available trials.

ClinTrial Refer provides extensive information about each study, including key eligibility criteria and trial site contact information. You have the option of using the

ClinTrial Refer mobile app or the ClinTrial Refer website to search.

Finding a suitable clinical trial can be difficult. ClinTrial Refer has created a free and easy-to-use search tool that can help match patients to studies using filters such as location, medical condition, sponsor, and trial status.

You can download the ClinTrial Refer app via the QR code below, by searching for it in your app store, or by visiting web.clintrialreferapp. com/searchTrial/list.

C in terms of recognition and support, and remains without an effective treatment.

Hep B Voices Australia was co-founded by Nafisa Yussf, Associate Prof Thomas Tu, Lien Tran, Uyen Vo and Dr Aye Aye Khaing.

The non-profit organisation aims to support, represent and advocate for the health and well-being of people affected by chronic hepatitis B in Australia.

“Lived experience is critical to adequately respond to hepatitis B. The voices of people living with hepatitis B should be integral to all aspects of the hepatitis B response,” Nafisa Yussf said. “This means people should be part of the design, development, implementation and decision-making of how we respond to hepatitis B.”

The website is in its early stages, but more content is appearing soon.

Liver Self-Repair

Liver regeneration as an alternative to waiting for a transplant

The liver is known for its ability to regenerate (see last issue’s cover story for more information). It can completely regrow itself even after two-thirds of its mass has been surgically removed. But damage from medications, alcohol abuse or obesity can eventually cause the liver to fail. Currently, the only effective treatment for end-stage liver disease is transplantation. However, there is a dearth of organs available for transplantation. Patients may have to wait from 30 days to over five years to receive a liver for transplant in the U.S. Of the over 11,600 patients on the waiting list to receive a liver transplant in 2021, only a little over 9,200 received one.

But what if, instead of liver transplantation, there were a drug that could help the liver regenerate itself?

I am the founding director of the Pittsburgh Liver Research Center and run a lab studying liver regeneration and cancer. In our recently published research, my team and I found that activating

a particular protein with a new medication can help accelerate regeneration and repair after severe liver injury or partial surgical removal in mice.

Key players in liver regeneration

The liver performs over 500 key functions in your body, including producing proteins that carry fat through the body, converting excess glucose into glycogen for storage and breaking down toxins like ammonia, among others.

Liver cells, or hepatocytes, take on these many tasks by a divide-and-conquer strategy, also called zonation. This separates the liver into three zones with different tasks, and cells are directed to perform specialized functions by turning on specific genes active in each zone. However, exactly what controls the expression of these genes has been poorly understood.

Over the past two decades, my team and other labs have identified one group of 19 proteins called Wnts that

play an important role in controlling liver function and regeneration. While researchers know that Wnt proteins help activate the repair process in damaged liver cells, which ones actually control zonation and regeneration, as well as their exact location in the liver, have been a mystery. identify these proteins and where they came from, my team and I used a new technology called molecular cartography to identify how strongly and where 100 liver function genes are active. We found that only two of 19 Wnt genes, Wnt2 and Wnt9b, were functionally present in the liver. We also found that Wnt2 and Wnt9b were located in the endothelial cells lining the blood vessels in zone 3 of the liver, an area that plays a role in a number of metabolic functions.

To our surprise, eliminating these two Wnt genes resulted in all liver cells expressing only genes typically limited to zone 1, significantly limiting the liver’s overall function. This finding suggests that liver cells

experience an ongoing push and pull in gene activation that can modify their functions, and Wnt is the master regulator of this process.

Eliminating the two Wnt genes from endothelial cells also completely stopped liver cell division, and thus regeneration, after partial surgical removal of the liver.

Liver regeneration after paracetamol overdose

We then decided to test whether a new drug could help recover liver zonation and regeneration. This drug, an antibody called FL6.13, shares similar functions with Wnt proteins, including activating liver regeneration.

Over the course of two days, we gave this drug to mice that were genetically engineered to lack Wnt2 and Wnt9b in their liver endothelial cells. We found that the drug was able to nearly completely recover liver cell division and repair functions.

Lastly, we wanted to test how well this drug worked to repair the liver after paracetamol overdose. Paracetamol, or acetaminophen, is an overthe-counter medication commonly used to treat fever and pain. However, an overdose of paracetamol can cause severe liver damage. Without immediate medical attention, it can lead to liver failure and death. Paracetamol poisoning is one of the most common causes of severe liver injury requiring liver transplantation in the U.S. Despite this, there is currently only one medication available to treat it, and it is only able to prevent liver damage if taken shortly after overdose.

We tested our new drug on mice with liver damage from toxic doses of paracetamol. We found that one dose was able to decrease liver injury biomarkers—proteins the liver releases when injured— in the blood and reduce liver tissue death. These findings indicate that liver cell repair and tissue regeneration are occurring.

Reducing the need for transplantation

One way to address liver transplantation shortages is to improve treatments for liver diseases. While current medications can effectively cure hepatitis C, a viral infection that causes liver inflammation, other liver diseases haven’t seen the same progress. Because very few effective treatments are available for illnesses like nonalcoholic fatty liver disease and alcoholic liver disease, many patients worsen and end up needing a liver transplant.

My team and I believe that improving the liver’s ability to repair itself could help circumvent the need for transplantation. Further study of drugs that promote liver regeneration may help curb the burden of liver disease worldwide. v

Satdarshan Singh Monga Professor of Pathology & Medicine, University of Pittsburgh Health Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article at bit.ly/3EAsv1T .

Jake’s Story

Haemophilia & the hep C cure

For Jake (name changed for privacy reasons), managing hepatitis C and taking care of his liver health has been a long journey, but every step has been worthwhile.

Jake has mild haemophilia. He first found out he had hepatitis C as a young boy in the 1980s when the children’s hospital called him in for testing. At the time he was more worried that he might have HIV, as that was a big concern for people with haemophilia.

“It was a strange time. When they told me and my parents that I had non-A non-B hepatitis—that’s what hep C was called then—the nurses were all gowned up and wearing gloves and masks. I had never seen it before. It was a bit like COVID.”

Liver health problems

After his diagnosis Jake was monitored regularly with liver function tests. His doctors explained that hep C might progress slowly and they would need to keep an eye on his liver health.

“For quite a few years there was little change and I didn’t think much about it. Then in my mid-20s the doctors could see some small differences in my liver function tests. I had a transjugular liver biopsy and that showed a little bit of damage in my liver.”

But suddenly in his early 30s his liver health started deteriorating and at a rapid rate. This was some years before 2016, when the new highly successful DAA hep C therapies became available in Australia. He commenced triple therapy treatment with telaprevir, interferon and ribavirin but did not respond to treatment.

“That was really disappointing and I was very upset. The next year I had another biopsy and they told me that I had definitely developed cirrhosis. Things got really bad for me then. I felt horrible, tired and very anxious.”

Hep C cure

With a combination of nonresponse to treatment and haemophilia, his options for clinical trials in Australia were very limited at the time. Desperate, he applied for clinical trials around the world and just as he was losing hope, he had a positive reply from a clinic in the USA. This was no ordinary situation. He persuaded the clinic he could take responsibility for himself and his health, his hospital in Australia provided all his clinical documentation, then he travelled to and from the USA to participate in the trial.

His hep C treatment was Harvoni (ledipasvir and sofosbuvir), one of the DAA therapies that are now widely available in Australia.

“I had one tablet a day for 12 weeks. Side effects? Some confusion and blurry vision, but my liver was in pretty bad shape so it might have been something else. And it all returned to normal as soon as I finished treatment. It was a piece of cake compared to interferon.”

When he received his results showing he had been cured of hep C, Jake was not surprised. “I already knew. I felt different. I felt good”

Cirrhosis monitoring

Even though his hep C has been cured, Jake had cirrhosis before treatment, which means he needs ongoing liver health monitoring.

“I have to have 6-monthly liver checkups because with cirrhosis I’m at an increased risk of cancer. I go to a liver clinic at the hospital to see a specialist – the same hospital as my Haemophilia Treatment Centre, just in case there are any issues with my haemophilia.”

Jake sees this as part of his routine care. He has some tests and a Fibroscan ultrasound, then follows up with an appointment with the specialist about a week later to discuss the results. With COVID, his specialist appointment is now via telehealth.

“It’s no big deal. As we get older, we need to be more

careful of our body anyway. The liver function tests are normal blood tests—I just have them every 6 months, along with other regular blood tests I have, like cholesterol and blood sugar. And I can do them at the pathology unit at the weekend if I want to. The ultrasounds are at the hospital. They are painless, take 5 minutes.”

While it can involve time off work, Jake thought the effort was well worth it.

“I don’t think anyone likes to have health checks all the time, but it is definitely peace of mind. If they find something, they can act on it straight away. You don’t want to find out down the track when there is not much you can do.”

Liver health and wellbeing

Since his hep C cure, Jake’s liver health has improved remarkably.

“I still have a bit of liver damage now, but it is not nearly as bad as before treatment. It’s amazing.

“Now that my liver is working better, everything is better. I have as much energy as when I was 21 years old. My moods are better. I don’t get itchy, I don’t get brain fog, I feel fine after a big meal.”

Jake has made changes to his lifestyle to take care of his health generally and thinks this has made a difference to his liver health recovery.

“I do help my body a lot. I haven’t drunk alcohol in 14 years. I don’t smoke. I walk a lot. I eat a Mediterranean diet and don’t eat much red meat or sugar.”

His message to others?

“We are living in different times. Anyone thinking about hep C treatment, just do it. Don’t hesitate. No one should live with hep C, especially these days. Treatment has never been easier.

“The damage to my liver happened so quickly. For years there was no change, then suddenly it went from bad to much worse. Make the effort to have treatment and follow up on your cirrhosis. Don’t give up. Life’s too short to take chances.” v

This story was first published on the Haemophilia Foundation Australia website ( haemophilia.org.au ) in July 2022, and is reprinted with permission.

Hep C Elimination Falling behind 2030 target

Suggested citation: Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022. Melbourne: Burnet Institute; 2022.

Suggested citation: Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022. Melbourne: Burnet Institute; 2022.

ISBN: 978-0-646-86972-8 DOI: 10.26190/ge22-aq55

ISBN: 978-0-646-86972-8

DOI: 10.26190/ge22-aq55

Burnet Institute Head Office 85 Commercial Road Melbourne, VIC, 3004 T: + 61 (3) 9282 2111 E: info@burnet.edu.au W: burnet.edu.au

Burnet Institute Head Office 85 Commercial Road Melbourne, VIC, 3004

T: + 61 (3) 9282 2111 E: info@burnet.edu.au W: burnet.edu.au /burnetinstitute @burnetinstitute

/burnetinstitute @burnetinstitute

The newly released 2022 annual report from the Burnet and Kirby institutes, Australia’s Progress Towards Hepatitis C Elimination, has a story of mixed success to tell. Unrestricted access to directacting antivirals (DAAs) through public subsidy since March 2016 means there is a real opportunity to reach the official government target of eliminating hepatitis C as a public health threat in Australia by 2030. However, at the end of 2020, an estimated 47% of people living with hepatitis C were yet to be treated, representing 117,800 people living with

Burnet Institute

Burnet Institute

chronic hepatitis. It is clear from data collated in this year’s report that declines in testing and treatment are substantial and ongoing. Without a reinvigoration of efforts to increase diagnosis, Australia will definitely not achieve its elimination goals (see summary graphic opposite).

To understand progress towards hepatitis C elimination, monitoring trends in data to assess the impact of these components is required, from measurement of new infections, counts of people tested and treated, and people receiving hepatitis

C-related liver transplants, through to projections based on mathematical modelling. This is the fourth national report on progress towards hepatitis C elimination in Australia. It brings together national data from across the sector, to give an overview on progress towards eliminating hepatitis C in Australia. This report also highlights gaps in our knowledge and informs future directions in Australia’s hepatitis C elimination response.

Kirby Institute Wallace Wurth Building UNSW Sydney, NSW, 2052

Kirby Institute

Wallace Wurth Building UNSW Sydney, NSW, 2052

T: +61 (2) 9385 0900

F: +61 (2) 9385 0920

E: recpt@kirby.unsw.edu.au

W: kirby.unsw.edu.au /thekirbyinstitute @kirbyinstitute

T: +61 (2) 9385 0900 F: +61 (2) 9385 0920 E: recpt@kirby.unsw.edu.au W: kirby.unsw.edu.au /thekirbyinstitute @kirbyinstitute

Designer: il Razzo admin@ilrazzo.com.au

Designer: il Razzo admin@ilrazzo.com.au

Australia has made considerable progress towards elimination in recent years with 95,395 people initiating DAA treatment between March 2016 and the end of 2021. Where available, the data show that numbers/rates of current infections have declined, particularly among the priority population of people who inject drugs and among HIV-positive men who have sex with men.

Of note, there has been a significant and increasing contribution of prison-based hepatitis services in progressing Australia’s elimination goals. In 2021, DAA treatment initiations in prison-based hepatitis services represented 41% of the total national DAA treatment initiations, an increase from 2019 (30%) and 2020 (37%). These data reflect the ongoing importance of

Eliminating hepatitis C in Australia

Eliminating hepatitis C in Australia

KEY FINDINGS

KEY FINDINGS

Where are we now 2022

Where are we now 2022

The rate of new infections has declined since 2016. This positive trend demonstrates Australia's progress towards reducing transmission.

The rate of new infections has declined since 2016. This positive trend demonstrates Australia's progress towards reducing transmission.

95,395 people received direct-acting antiviral (DAA) treatment between March 2016 and the end of 2021.

95,395 people received direct-acting antiviral (DAA) treatment between March 2016 and the end of 2021.

Between the start of 2016 and the end of 2020, 43% of people living with hepatitis C had been treated.

Between the start of 2016 and the end of 2020, 43% of people living with hepatitis C had been treated.

Medicare data shows declines in testing since 2016.

Medicare data shows declines in testing since 2016.

The number treated each year continues to decline.

The number treated each year continues to decline.

At the end of 2020, an estimated 117,800 people were still living with hepatitis C, highlighting the challenge remaining to eliminate hepatitis C in Australia.

At the end of 2020, an estimated 117,800 people were still living with hepatitis C, highlighting the challenge remaining to eliminate hepatitis C in Australia.

More investment is needed to tackle experiences of stigma, which have not improved between 2018 and 2021.

More investment is needed to tackle experiences of stigma, which have not improved between 2018 and 2021.

Challenges remain in ensuring equitable access to treatment across metropolitan, rural, and remote locations.

Challenges remain in ensuring equitable access to treatment across metropolitan, rural, and remote locations.

The COVID-19 pandemic increased challenges to accessing health care for people a ected by hepatitis C.

The COVID-19 pandemic increased challenges to accessing health care for people a ected by hepatitis C.

Source: Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022.

Melbourne: Burnet Institute; 2022.

Source: Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022. Melbourne: Burnet Institute; 2022.

the justice sector to eliminate hepatitis C and underscore the crucial role prison hepatitis services play in reaching people at risk of hepatitis C and Australia achieving its elimination goals.

Despite these successes over the past six years, that still leaves us to face the uncomfortable figure of 117,800 people living with chronic hepatitis C, highlighting the considerable challenge that remains to eliminate hepatitis C in Australia.

Levels of hepatitis C testing, and therefore diagnosis and

treatment have declined. While this decrease in the number of people living with hepatitis C who have been tested and was observed prior to the COVID-19 pandemic, the pandemic definitely exacerbated the decline and continues to create additional challenges to accessing health care for people affected by hepatitis C (see next page).

To ensure elimination goals are met health promotion campaigns are needed to ensure key risk populations are aware that treatment and retreatment is available to them and to encourage them to engage in care.

THE COVID-19 FACTOR

To examine how COVID-19 related restrictions changed uptake of HCV antibody and HCV RNA testing, data from 11 ACCESS clinics located in Victoria which specialise in the care of people who inject drugs were included in a careful analysis.

Data from all services during the 125 weeks between 1st January 2019 and 25th May 2021 were included, thus including a year of data from before the pandemic, as well as more than a year of data once the pandemic began.

Pre-COVID, an average of 80.6 HCV antibody and 25.7 HCV RNA tests were performed each week (note that a declining trend was observed prior to COVID-19-related lockdowns).

After the first lockdown in Victoria (April 2020), there was an immediate drop of 23.2 HCV antibody tests and 8.6 HCV RNA tests per week (equivalent to a 30.9% and 46.0% drop, respectively).

After the second Victorian lockdown (July 2020), there was an immediate drop of 17.2 HCV antibody tests and 4.6 HCV RNA tests per week (equivalent to a 26.2% and 33.3% drop, respectively).

Some recovery in HCV antibody testing in the months following the lockdowns was observed, but the average level of HCV antibody testing had not returned to pre–pandemic levels by the end of May 2021.

It is important to note that Victoria’s lockdowns were the most severe for an state in Australia.

Considerable effort and investment are also needed to support the provision of accessible, simplified, and convenient models of testing and treatment, to ensure people living with or at risk of hepatitis C access testing, are retained in care, and complete treatment in a timely fashion.

This may include novel models of care such as point-of-care testing, of the sort Hepatitis SA is heavily involved in, as well as peer-led models of care, testing and treatment in non-traditional settings such as pharmacies, and expanding drug treatment programs to include hepatitis C care.

Expanding models of care also requires supporting the relevant workforce through education and skill development.

There also needs to be ongoing investment in the prevention of new infections and reinfection through harm minimisation, including in prisons.

Importantly, this report highlights that stigma and discrimination towards people at risk of and living with hepatitis C remains prevalent. Interventions to reduce stigma in the community and health care settings will be necessary to increase engagement with hepatitis C testing and treatment services and continue progress towards hepatitis C elimination.  2030 is close, and more action is needed now. v

Results provided on same day as test.

For more information, select number 8 from the ‘Common Access List’ for a free call from any prison phone, or ask for Lisa at HepSA on 8362 8443.

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!

M ANAgINg yOUR ALCOHOL INTAKE

Daybreak app: change your relationship with alcohol

Hello Sunday Morning, Sydney, 2022. Phone app. We’ve featured this one before but it’s worth revisiting at this time of year: a 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. bit.ly/daybreakapp

Celebrate with a happy liver

Keeping your liver as healthy as possible during times of celebrations and holidays can be difficult—but doesn’t mean you have to miss out on the fun!

These resources focus on some of the issues that can be problematic during (and after) festivities: such as diet, alcohol, stress and exercise. They offer tips to keep yourself safe and healthy—especially if you have liver disease.

Coronavirus: it’s tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check

The Conversation, Melbourne, Sydney, 2020. 4p.

With a focus on COVID but has information relevant to any stressful situation: outlines the different ways that alcohol can affect mood, sleep patterns, emotional and physical health. Gives tips for how to manage alcohol consumption and how to manage stress without alcohol. bit.ly/healthystressmgmt

standard drink sizes), signs that you might need to cut down on drinking and how to manage alcohol intake. bit.ly/alcohol_hep

Alcohol and hepatitis

Hepatitis Queensland, Brisbane, 2019. 2p. factsheet. Information about how alcohol affects hepatitis (and treatment): safe levels of drinking (with images for

The festive season

Mental Health Commission WA, Perth, 2021. 4p. Tips for how to re-think our drinking culture and the way we drink, whether it’s when we go out for celebrations or host our own parties. Also lists some alcohol myths and facts especially relevant to the festive season. bit.ly/thefestiveseason

H EALTH y EATINg TIPS

Quirky delights – and other healthy cooking publications

Hepatitis SA, Adelaide. 3 booklets, 1 blog

Links to: ‘Quirky delights’ (unusual liver friendly treats); ‘Keep it simple’ (healthy and economic recipes); ‘Eating low salt’ (tips for reducing sodium for people with liver disease) and ‘Eat well for your liver’ (tips and recipes). Readonly online: contact admin@ hepsa.asn.au for hard copies. NB: may need to disable any ad blockers for full access to resources on ISSUU. bit.ly/hepsa_recipes

Eating Well: a LiverWELL lifestyle guide

LiverWELL (Hepatitis Victoria), Melbourne, 2019. 50p. Eating well and maintaining a healthy weight can improve liver health and prevent certain chronic medical conditions. This illustrated book is available for download by anyone looking for recipes plus hints and tips to help improve their liver health. bit.ly/liverwell_eating

Ex ERCISE

Exercise for healthy livers

Adelaide Hepatitis SA, Adelaide, 2022 (rev). 3 fold brochure.

Information about: why exercise is important, what types of exercise are useful, how it helps - and tips for how to get started. Read only online (important note: may need to turn off ad blockers to view complete ISSUU resources). For printed copies email admin@hepsa.asn.au. bit.ly/hepsa_exercise

STRESS

Mindfully meditations

Australian Broadcasting Corporation, Sydney, 2020. Online audio series. A series of 9 short meditations (7-15 minutes) based on the concept of mindfulness and designed to assist with developing meaningful and stress free relationships. abc.net.au/radio/programs/ mindfully/episodes

A ND AFTER ALL THAT INDUL gENCE

Liver detox diets and Traditional Chinese Medicine: Do they work?

Hepatitis Australia, Canberra, 2020. 2p. Looks at liver anatomy and what detox diets, supplements and traditional Chinese medicine are thought to do in terms of liver health - and whether this is supported by evidence. Includes a reference list for further information. bit.ly/hepaust_liverdetox

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

1300 224 636 www.beyondblue.org.au

Clean Needle Programs in SA

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

Hutt St Centre

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

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

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

MOSAIC Counselling Service

For anyone whose life is affected by hepatitis and/or HIV. (08) 8223 4566

Nunkuwarrin Yunti

An Aboriginal-controlled, citybased health service, which also runs a clean needle program. (08) 8406 1600

Viral Hepatitis Community Nurses

PEACE Multicultural Services

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

(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 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

NORTH Bin: 0401 717 971

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 Bin on 0401 717 971