#83 HepSA Community News

#83 • October 2019

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

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

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Editor: James Morrison

Contents

1 Migration & Hep B 2 Hep C Elimination

HEPATITIS SA BOARD Chair Arieta Papadelos Vice Chair Bill Gaston Secretary Deb Perks Treasurer Michael Larkin Ordinary Members Julio Alejo Catherine Ferguson Sharon Jennings Maggie McCabe Sam Raven Kerry Paterson (EO)

ISSN 2651-9011 (Online)

4 Shuping Wang 6 Elimination Conference

Highlights 10 Treatment Priorities 11 Treatment &

Homelessness 13 What’s On? 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.

Migration & Hep B

Changes to immigration health requirements a positive move

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n 1 July 2019, the Australian Government made changes to the immigration health requirement, which prevents migrants with an illness, disease or disability from gaining a visa if their healthcare costs are considered too high, or their condition puts the general public at risk.

Prior to the changes, if a person was applying for a visa, the threshold for which their healthcare costs were deemed too high was $40,000 over the applicant’s lifetime. The threshold has now been increased to $49,000, and the timeframe reduced to 10 years. This is an especially significant and positive change for people living with chronic illnesses like hepatitis B who are seeking to migrate

permanently to Australia. In the case of hepatitis B, the costs of treatment are very unlikely to exceed the new threshold in a 10-year period.

A substantial proportion of migrants to Australia come from regions where hepatitis B is a common condition across the whole population.

However, the rate of diagnosis often remains low.

To protect their long-term health and reduce the risk of onward transmission, testing is recommended for all people with a risk of hepatitis B, including those from highprevalence regions.

Hepatitis B testing in migrant populations is essential to facilitate global and national elimination goals. The prior visa restrictions worked against the elimination goals, as a hepatitis B diagnosis

could jeopardise someone’s visa applications. The change from 1 July is therefore very welcome and will help enable diagnosis and linking people to low-cost healthcare, which in turn is protective for all Australians.

While this is a great step forward, for a smaller group of people with more advanced liver disease, the future cost of medical treatment is likely to still exceed the threshold and further work is needed to ensure hard-working migrant families are not negatively impacted. Australia’s notoriously harsh migration system needs more reform.

At Hepatitis SA we strongly encourage all people who could be at risk of hepatitis B to get tested. Talk to your GP or a Liver Health Nurse today. v

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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Elimination in Sight?

Australia’s success in the fight against HCV

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he first national report on progress towards the elimination of hepatitis C virus in Australia highlights the great strides Australia has made towards hepatitis C elimination over the past two to three years, with over 70,000 Australians having accessed the cures known as direct acting antivirals (DAAs) by the end of 2018.

Hepatitis C is a significant public health issue in Australia, currently affecting over 160,000 people. Until DAAs became available to all Medicare-eligible Australians with chronic hepatitis C infection in March 2016, there was a growing number of people living with hepatitis C, a rising burden of liver disease, and increasing rates of liver cancer and premature deaths attributed to long-term hepatitis C infection.

Prepared by Burnet Institute and the Kirby Institute, the report highlights this is now changing with declining numbers of new hepatitis C infections occurring each year.

Key points from the report: •

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Over 70 000 Australians have accessed DAAs, highly effective and curative hepatitis C treatments

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The uptake of treatment has been accompanied by declines in new hepatitis C infections

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There is declining hepatitis C incidence among people who inject drugs, HIV-positive gay and bisexual men and lower prevalence of infection among recent injectors suggesting early evidence of a treatment as prevention benefit

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Hepatitis C notification linked data also indicates a decline in advanced liver disease complications and liver-related deaths.

“Australia should be proud of the great progress we have made towards hepatitis C elimination. We are one of the few countries globally on track to achieve the WHO target of eliminating hepatitis C as a public health threat by 2030,” report contributor, Burnet Deputy Director, Professor Margaret Hellard AM, said.

“There are challenges ahead.

In particular a further 140,000 Australians need treatment, many who may not know they are infected or that a highly effective cure exists. We need to get the message out to them.”

In Australia, hepatitis C is mostly transmitted by the

HEPATITIS SA COMMUNITY NEWS 83 • October 2019

sharing of needles during injecting drug use.

“Anyone who has injected drugs recently or in the past is at risk of hepatitis C. Importantly these curative therapies are available for all Australians no matter how they got infected, including through injecting drug use.

We encourage people to have a conversation about hepatitis C, get tested, treated, and cured.

Tell a friend or family member who may be at risk to do the same.” (See p4 for the latest research on hepatitis C rates among those who inject drugs.)

A major strength of Australia’s response is the partnership approach, with key community

organisations, government, the health sector and researchers working together to achieve elimination.

Report co-contributor, the Head of Kirby’s Viral Hepatitis and Clinical Research program, Professor Greg Dore, said this partnership approach is a key role to Australia’s response.

“Australia is one of the few countries in the world where hepatitis C treatment can be accessed in the primary health care setting and it is central

to our progress,” Professor Dore said. “Australia’s approach involving GPs, nurses, pharmacists and peer workers is a great strength. It helps raise awareness about treatment and linking people to care.

“As well, care is taking place hand in hand with another key component of Australia’s hepatitis C response, prevention through harm reduction. It means for many people there can be a one-stop shop—they can access clean

needles and syringes and opioid substitution therapy to reduce their infection risk, but also, if infected, access testing and treatment so they can be cured of hepatitis C.” While the report shows a strong uptake of HCV testing and treatment among people who inject drugs and HIV-positive gay and bisexual men attending particular clinics, it also reveals disparities in rural and regional Australia, and a lack of data on the uptake of treatments by priority populations including Aboriginal and Torres Strait Islanders, and prisoners.

Stigma and discrimination against these key populations also remains an issue in ensuring they access care.

As well, there has been a slowdown in the uptake of testing and treatment overall in the past 12 months.

These issues will be a focus of Australia’s efforts going forward.

The report was compiled from 23 separate sources across Australia, from publicly available datasets through to mathematical modelling to give an overview of progress towards hepatitis C elimination in Australia. v

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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Remembering a Hero

The bravery and activism of Shuping Wang

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histleblower and activist Shuping Wang has died of a heart attack in the US, her adopted home, while hiking with her husband. Doctor Wang was responsible for saving tens of thousands of lives. It was her campaigning in China during the 1990s that finally forced the hand of the government, leading to blood banks finally testing blood for hepatitis C and HIV in the world’s most populous nation.

The Guardian’s Mattha Busby reported that “In 1992,

Wang raised the alarm over how blood plasma donors were being contaminated with the blood of donors infected with hepatitis C when the blood of the latter was injected into the plasma donors’ bodies. Even after her recommendations were taken up, Wang faced intimidation as officials tried to cover up the public health crises.”

Wang wrote that “my own investigation found the hepatitis C antibody positive rate to be as high as 84.3%.

Being a doctor, I was very anxious. I knew that hepatitis C and HIV had the same routes of infection … I didn’t want to sit in the office of the Health Bureau waiting for the arrival of an AIDS epidemic. I wanted to directly monitor it and prevent it.”

Busby explained that the Chinese Ministry of Health in Beijing “began requiring hepatitis C screening for blood plasma donors in 1993 after Wang spoke out, but she was attacked, lost her job

Dr Shuping Wang in her adopted country

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HEPATITIS SA COMMUNITY NEWS 83 • October 2019

A scene from The King of Hell’s Palace

and had her clinic vandalised.

Then, in 1995, she uncovered another scandal in which HIV-positive donors were giving blood in a number of different areas. Wang told her superiors to test for HIV in all blood collection stations in Henan province, but was told it would be too costly.

half a million often poor people were thought to have been infected with HIV after selling their blood to collection centres in central China.”

“She bought testing kits herself and found the HIVpositive rate among 400 donors to be 13%. As a result of her investigation, collection sites across China were shut down and later reopened with HIV testing.

Wang left China in 2001 and never returned, feeling unsafe. She moved to the US and became a citizen.

A play based on her story, The King of Hell’s Palace, is currently playing in London, and Wang’s family has been targeted by Chinese authorities in an attempt to have the production closed down.

“In 2001, the government admitted that more than

“The only thing harder than standing up to the

government and their security police is not giving in to pressure from friends and relatives who are threatened with their livelihoods, all because you are speaking out,” she said.

“But even after all this time, I will still not be silenced, even though I am deeply sad that this intimidation is happening yet again.”

Doctor Shuping Wang was 59.

Read more from the Guardian story at bit.ly/2n7viKr. Details on The King of Hell’s Palace can be found at bit. ly/33tsYOK. v

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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New Perspectives

Lessons learned from the Second Australasian Viral Hepatitis Elimination Conference

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he Second Australasian Viral Hepatitis Elimination Conference was held in Sydney from 5-6 August 2019, and consisted of presenters working in diverse fields, and from a number of countries. Below are pertinent and interesting lessons that I learnt.

insightful observations about the cultural differences in interpreting silence.

He explained that during conversations, many people from Western cultures will take silence as a sign that a person agrees with them. In these cultures, if a person disagrees, they will say so.

figure, which is often the case when the speaker is a health professional. Therefore, if people from non-Western cultures disagree with what is being said, they may well remain silent as to not be impolite, and if they agree, they will openly show it with words and/or gestures.

Interpreting Silence

Conversely, in many nonWestern cultures, people feel rude openly disagreeing with others, especially if they view the person who is speaking as an authority

It is important to learn and note these differences in cultural understandings.

Having an awareness of these issues can assist health professionals and

Professor Chris Cunningham from Massey University in New Zealand provided

Image derived from photo by tirachardz [freepik.com]

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HEPATITIS SA COMMUNITY NEWS 83 • October 2019

Image by freepik [freepik.com]

community workers to alter their practices, and improve their ability to provide health information to others. Workers can learn to recognise the silence of others, and carefully draw out the opinions and thoughts of their clients for further discussion.

Nursing

Dr Jacqui Richmond from the Burnet Institute implored the audience to reflect upon the significant but woefully under reported role of nurses in the goal of viral hepatitis elimination. While nurses play a fundamental role in facilitating access to hepatitis C treatment, much of their work is not included in official data sources, and thus often goes unreported in official reports.

Many states and territories know that additional

nursing support is key to streamlining treatment services (and our ultimate goal of elimination), yet data is required to make a solid case for funding, and this data we do not usually collect.

Furthermore, the work of a nurse is difficult to capture in an official capacity. Their functions are so vast and varied—a simple data sheet will never encapsulate the full extent of their efforts.

Nurses not only engage people in testing and treatment, offer linkages to care, prevent further infections, identify people at risk, assess people, provide treatment care, support adherence, educate, advocate, provide fibroscans and posttreatment monitoring for liver cancer, they also spend time building relationships and rapport with people from

marginalised populations in settings that can be rife with stigma and discrimination.

They remember to check in with people to see if they are in a better position to access care after declining previous offers, they plant seeds in the minds of their patients about testing and treatment, and, overall, they provide vital people-centred care. These things are endlessly valuable, but difficult to measure.

Nurses are abundantly adept at working with others, including other nurses, doctors, specialists, patients, carers, and hospital administrators. To solve the ‘data problem’, Dr Richmond suggests that nurses also need to begin working with researchers, and those who are proficient at collecting data, to start recording all the hard work they undertake.

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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Natali Smud from Multicultural HIV and Hepatitis Service (MHAHS) in New South Wales emphasised why people from Culturally and Linguistically Diverse (CALD) communities may harbour additional fears of being diagnosed with a blood-borne virus (BBV) due to discriminatory practices in their country of birth. For example, previously in China, it was illegal for people living with BBVs to work in the government. Furthermore, children living with BBVs were often excluded from childcare.

During another presentation, Dee Lee from the Inno Community Development Organisation in China observed that some workplaces in China have specific lunchrooms for

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Image by fanjianhua [freepik.com]

» Culture vs BBVs

people living with BBVs, something which we hope would be unthinkable in Australia. In many countries, discrimination against people living with BBVs is, or was until recently, legal.

This means that more than just the health implications of a diagnosis need to be considered –a diagnosis can also have significant economic and social implications. Someone could be fired from their job in the government, or have to quit their job to care for a child who was excluded from childcare, or have their personal health information unfairly divulged to their colleagues due to their assigned lunchroom.

Those who work in the BBV sector in Australia need to understand that many people carry emotional scars from these practices in their home

HEPATITIS SA COMMUNITY NEWS 83 • October 2019

countries. Understandably, people often do not want an official diagnosis or medical record of their BBV status in case they return to, or visit, their country of birth. And with these experiences, they also fear unknown consequences that they might experience in Australia.

Traditional Medicine

Dee Lee also explained that many people from China often turn to traditional Chinese medicine, as they are lacking information about the phases of the hepatitis B virus.

The hepatitis B virus has four phases, and some phases require a person to take medication. When managed correctly, people living with chronic hepatitis

B have 6-monthly blood tests to determine the current phase of their virus, and whether or not to take this medication. Due to a lack of clear information, many people living with the hepatitis B virus may see their doctor regularly and wonder why no medication is being prescribed. This makes people feel like they, or their doctor, are not being proactive in managing the virus. They feel a loss of control, and at great risk from liver-related harms.

Therefore, they turn to alternative therapies. Health care workers are advised to clearly and thoroughly explain the phases of the virus, and the reason that, at certain times, no medication is recommended.

Papers, posters and audio rcordings from the conference are available at www.avhec2019.com.au. v Shannon Wright Educator

Call Us!

Free, confidential information and support on viral hepatitis:

1800 437 222 October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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“I’ll have hep C treatment eventually.”

Competing priorities for people who inject drugs

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pioid substitution treatment (OST) clinics are considered ideal locations for providing treatment for people with chronic hepatitis C virus infection who inject drugs, a vital priority group for achieving the goal of HCV elimination. But despite the availability of highly effective treatments with relatively few side effects, treatment uptake is yet to reach the level needed to achieve elimination.

Research led by Heidi Coupland, of Drug Health Services in the Sydney Local Health District, explored competing priorities among clients, clinic staff and policy makers, and the resulting barriers to beginning HCV treatment in OSTs. Coupland’s team conducted in-depth interviews with clients and staff from two hospital-based opioid substitution treatment clinics in Sydney. The interviews were then

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thematically and rigorously analysed.

For the majority of clients— more than three quarters— HCV treatment was not a priority and many preferred to postpone treatment. Work and family obligations, health problems, focusing on drug treatment issues, and perceptions that HCV was an additional and unwanted commitment and responsibility, shaped clients’ decision-making. “I’ll have hep C treatment eventually,” was the overall theme.

Clients also identified concerns about side-effects and the barriers posed by the multiple steps involved in pre-treatment testing and getting scripts filled. Many clients (69%) reported that clinic staff strongly encouraged them to commence treatment, and they perceived staff to have a clear agenda during their interactions.

HEPATITIS SA COMMUNITY NEWS 83 • October 2019

OST clinics are required to harness considerable resources to make testing and treatment more accessible for clients, given their existing staff capacity and both institutional and prescribing-related barriers. Data gathered from the interviews highlighted the need for adequate staff and appropriate record-keeping systems for capturing and storing relevant tracking data to facilitate client linkage to treatment, and for reporting progress.

The study found that eliminating HCV in Australia’’s resourceconstrained OST settings requires a marked reorientation of the available resources. Given the disparities between the priorities of clients and staff regarding treatment uptake, real challenges persist in maintaining client-centred service provision for a population with multiple health and social needs. v

Homelessness vs treatment Image by Macrovector

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ith liberal access to direct acting antivirals in Australia, and recommendations for all people living with HCV to be treated, most people accessing clinical services should be treated. A study led by Rosie Gilliver of the Kirketon Road Centre in Sydney’s Kings Cross describes a cohort of individuals aware of their HCV diagnosis but who have yet to initiate treatment despite its recommendation.

Every Kirketon Road Centre client with detectable HCV RNA who was worked up for DAA therapy between March 2016 and March 2019 was included in the study, though clients known to have been treated at another service were excluded. Demographic, behavioural, attendance and clinical variables were factored into the results.

Clients known to the service for less than a month prior to their HCV assessment were considered existing clients.

During the 3-year timeframe, 456 individuals were diagnosed and assessed for DAA treatment. Of these,

328 individuals commenced DAAs at Kirketon Road, with 128 clients remaining untreated. Overall treatment uptake was therefore 72%.

The results showed that clients receiving Opioid Substitution Treatment (see previous page) were no more likely to initiate treatment than those not receiving OST: 81% versus 77% Those experiencing homelessness were significantly less likely to initiate treatment than those who were not homeless: 78% versus 89%.

Those reporting recent injecting drug use were equally likely to initiate treatment as those reporting no recent use: 73% versus 69%.

No other demographic factors, including gender, Aboriginality, or other variables such as attendance at outreach or main site locations or duration of

relationship with the service were significantly associated with lower treatment uptake.

So, homelessness was shown to be the most notable factor in affecting the client’s going onto treatment. But it’s important to note that those clients who are housed and who attend Kirketon Road are still often highly socially disadvantaged, and it is clearly important that someone’s current housing status does not lead to an assumption of likely engagement in care.

Despite high overall treatment uptake, a significant proportion of clients remain untreated. Many still attend the service, but have not commenced treatment despite it being offered.

Significant social instability compromised Kirketon Road’s capacity to work up and initiate treatment with these clients. v

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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y a D h t l a Liver He CHN) (W k r o tw e N h lt a e H ’s Women’s & Children e id la e d A t r o P t, e e tr S le 47 Da

r e b o t c O 1 2 , y a Mond

k c e h C h lt a e H r e iv L Have your Free pm 3 d n a m a 0 1 n e e w bet d r a C t if G 5 2 $ a in w o for a chance t titis SA a p e H t a a s Li ll a c n o ti a rm For more info on 8362 8443

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HEPATITIS SA COMMUNITY NEWS 83 • October 2019

Affected by he

Affected by hepatitis C? Photo © S. Allen

Hepatitis C peer educators are available to provide treatment information and support to clients at the following services: Free Fibroscan Clinics (No bookings required) •

Calming the C

•

• Information and support in a confidential, friendly environment • Speak to others who have had treatment • Partners, family and friends welcome

Now meeting at HACKNEY, ELIZABETH PORT ADELAIDE: and PORT ADELAIDE Wonggangga Turtpandi For information, phone 8362 8443 12–2pm 12.30–2.30pm See over for• dates Tuesday, 17 September • Tuesday, 22 October HACKNEY: 3 Hackney Rd

•

Tuesday, 17 December

•

The SMART (Self Management and Recovery

Training) Recovery group meetings run for 90 minutes each Wednesday, from 5.30pm at 3 Hackney Road, Hackney, in the meeting room at the rear of Hepatitis SA.

Calming

Bookings Now required meeting •

Tuesday, 12 November

2019 Dates announced soon

Free, after-hours support is available for anyone struggling with addictive behaviour.

•

Hutt Street Day Centre: 3rd Wednesday of each month, 9.30–11.30am, 258 Hutt St, Adelaide SA 5000 WestCare Services; 4th Thursday of each month, 9.30–11.30am, 11/19 Millers Ct, Adelaide SA 5000 Wonggangga Turtpandiand support • Information Aboriginal Primary Health friendly environment Care Service (Pt Adelaide • Speak to others who hav CNP); 1st Wednesday of each • Partners, family and frien month, 9.30–11.30am, 11 Church St, Port Adelaide SA 5015

•

at HACKN

Anglicare Elizabeth Mission; and PORT ADE 2nd Friday of each month, information, 9.30am–12For pm, 91-93 Elizabeth phon Way Elizabeth (Bookings See via over for reception in person, or call 8209 5400) Noarlunga GP Plus; fortnightly, Alexander Kelly Dr, Noarlunga Centre SA 5168 (Bookings via Noarlunga CNP Peer, or by calling Rosalie on 0466 777 876)

The program can assist with any problematic behaviours, including addiction to drugs, alcohol, cigarettes, gambling, food, shopping, internet and others. Focus is upon the addictive behaviour, not the substance itself.

For more information, call Lisa on 8362 8443, or visit smartrecoveryaustralia.com.au.

October 2019 • HEPATITIS SA COMMUNITY NEWS 83

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Liver Disease: How will hep C affect me? testcurelive.com.au/ symptoms-of-hep-c Hepatitis Australia, Canberra, 2019. 2p.

New treatments for Hepatitis C have very few, if any, side effects. But for those who have been living with the virus long term the liver may no longer be fully functional. A liver that is struggling may result in symptoms such as fatigue, itchy skin, brain fog or fluid retention. The following resources contain information that can assist with understanding, alleviating or coping with chronic illness symptoms through medical assistance or lifestyle changes.

Most people with chronic hepatitis C do not experience any symptoms unless their liver is already damaged: this article lists the possible symptoms with references for further information.

bit.ly/livercirrhosis_ hepnsw Sydney Hepatitis NSW 2018. 44p booklet.

Detailed information about symptoms, treatments, self-care etc. Also contains an appointment diary, weight tracker and meds tracker.

Hepatic Encephalopathy action plan

If you have any problems accessing these materials please let us know at admin@hepsa.asn.au.

bit.ly/he_actionplan Flinders Medical Centre, Adelaide, 2017, 1p.

Chronic illness bit.ly/healthcheck_chronic Melbourne Dept of Health & Human Services, Vic. 2018 3p.

Useful information about the characteristics, common stresses, additional demands, type of help available, ways to cope, children with a chronic illness, and where to get help.

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Liver cirrhosis: a toolkit for patients

HEPATITIS SA COMMUNITY NEWS 83 • October 2019

Brief information about what it is, how to recognize it, how to manage it, and warning signs for when to seek medical help.

recognizing and managing symptoms Ascites: causes, symptoms, and treatment

Living with advanced liver disease: helpful hints

bit.ly/ascites_causetreat

issuu.com/hepccsa/docs/ living_with_advanced_ liver_disease_

Medical News Today, Bexhill-on-Sea, 2017. 6p.

Hepatitis SA, Adelaide, 2013. 22p.

Brief information about ascites (build up of fluid in the abdomen) which can occur when the liver is not fully functional: the causes, symptoms, diagnosis, treatment and outlook.

Put together after conversations with people who have lived experience: topics covered include how to deal with eating difficulties, low/ no salt foods, itchy skin, confusion and memory loss and emotions.

Living with Advanced Liver Disease

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Hepatitis C: brain fog and fatigue

Helpful Hints

bit.ly/hcvbrainfog Smart+Strong, New York , 2015 3p.

Lucinda Porter (hepatitis advocate and health educator) discusses the causes and effects of brain fog and fatigue for people living with hepatitis C. Includes lifestyle tips for how to alleviate the symptoms.

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October 2019 โ ข HEPATITIS SA COMMUNITY NEWS 83

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26 NATIONAL HEPATITIS SYMPOSIUM TH

WHEN

Saturday November 23, 2019 8am – 4pm WHERE

Australian Catholic University Building 404 (off Young St) 115 Victoria Pde, Fitzroy

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HEPATITIS SA COMMUNITY NEWS 83 • October 2019

INTERNATIONAL SPEAKER

Dr Raymond Chung Massachusetts General Hospital & Harvard Medical School

REGISTER

www.trybooking.com/BFFTP

SPONSORS Gilead AbbVie MSD Novo Nordisk

ENQUIRIES

genevieve.cullity@svha.org.au

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 with clean needle program and liver clinic.

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

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

Lifeline National, 24-hour telephone counselling service.

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

13 14 65

1300 224 636 www.beyondblue.org.au

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

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

(08) 8223 4566

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

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

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

(08) 8406 1600

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

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

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

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

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

Debbie/Rose - 0401 717 953

North: Lucy - 0401 717 971

Michelle - 0413 285 476

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

Jeff - 0466 777 873

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

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

hepsa.asn.au

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HEPATITIS SA COMMUNITY NEWS 83 • October 2019