#89 HepSA Community News

Community News

#89 • April 2021

COVID Vaccines for People with Hepatitis

Plus New HCV Test Technology and more

FREE!

Please take one

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

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

Street Address: 3 Hackney Road, Hackney

Cover: Image by James Morrison, using element (pencil) by Marco Verch [flickr.com/photos/30478819@N08]

Postal Address:

Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email editor@hepatitissa.asn.au.

Phone:

Editor: James Morrison

PO Box 782 Kent Town SA 5071

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 Bernie McGinnes Sam Raven Kerry Paterson (CEO)

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

Contents

1 Hep B & Pregnancy 2 Hep C Standard of Care 4 COVID-19 Vaccines

& Hepatitis 6 Jude Byrne 8 New HCV Tests 11 Eating In 14 In Our Library 16 W hat’s On? / CNP Info Disclaimer: Views expressed in this newsletter are not necessarily those of Hepatitis SA. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist.

We welcome contributions from Hepatitis SA members and the general public.

SA Health has contributed funds towards this program.

ISSN 2651-9011 (Online)

Hepatitis B in pregnancy In early pregnancy, you should be tested for HEPATITIS B!

If you test negative (HBsAg-)

Your immediate family and sexual partners should be tested.

If you test positive (HBsAg+)

If they are not immune, they can get the vaccine series to be protected. If they have hepatitis B, they too should get care.

You should discuss further testing and treatment with your healthcare provider.

Get hepatits B vaccine (1)

2021

1

3

2

at birth Your baby should get a hepatitis B birth dose within 24 hours of birth. (2)

Always talk to your healthcare provider about testing, treatment and vaccination options available to you

You may need antiviral medication in the 3rd trimester to reduce the risk. Ask your medical provider to refer to WHO recommendation on prevention of mother-to-child transmission of hepatitis B.

1-2 Months

6 Months

9-12 Months

Your baby receives the 2nd dose of hepatitis B vaccine. (3)

Your baby receives the 3rd dose of hepatitis B vaccine. (3)

Your baby should have a blood test to check if they are protected against hepatitis B. (4)

For further support please contact a World Hepatitis Alliance member near you

1) The hepatitis B vaccine series is safe to give during pregnancy or can be given after 2) The birth dose should be a vaccine that only has hepatitis B in it (not a pentavalent vaccine) 3) This may be part of a combined vaccine (ex: pentavalent vaccine) 4) The tests are Hepatitis B surface antigen & hepatitis B surface antibody.

If they are not immune, a second round of vaccines is indicated.

Breast Feeding There are many benefits of breastfeeding your baby.

The World Health Organization (WHO) recommendation is that women who have hepatitis B can safely breastfeed their baby.

Hepatitis B is not transmitted through breastmilk.

Breastfeeding mothers with cracked nipples should practice proper nipple care.

For more information please visit www.who.int, www.nohep.org/moms and www.worldhepatitisalliance.org.

World Hepatitis Day is coming: Wednesday, 28 July 2021 April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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Hep C Standard of Care 12 good practices that should be included

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epatitis C programmes and health services should review whether they are using best practices in diagnosis, treatment and care of people with hepatitis C, and update service models to improve hepatitis C elimination efforts, according to a review published this month.

The review, carried out by a team at the Barcelona Institute for Global Health and colleagues at universities in Denmark, Italy, Sweden and the United Kingdom, identified 12 good practices that should be scaled up in order to improve diagnosis of hepatitis C, uptake of treatment and retention in care.

The research team scanned the scientific literature, conference abstracts and reports on best practice to identify evidence for innovations in screening and care that have led to improved outcomes.

practice they identified are already being implemented in Australia, Spain and the United Kingdom, which are three of the nine countries on track to achieve hepatitis C elimination by 2030.

Screening and diagnosis

Reflex testing, the practice of automatically testing hepatitis C antibody-positive blood samples for hepatitis C virus (RNA testing), eliminates the need for a person who tests positive for antibodies to be recalled for further testing.

Reflex testing increases the rate of diagnosis of chronic hepatitis C infection. Implementation of reflex testing is practiced widely in Spain.

Alternative diagnostic methods to help people move from hepatitis diagnosis

The researchers say that most of the examples of good

to cure are also needed, especially point-of-care tests that can give results within 20 minutes or an hour. Again, these can eliminate the need for multiple visits and blood draws, for example through siting the Gene Xpert RNA testing platform in drugs services. Testing for hepatitis C core antigen can eliminate the need for confirmatory RNA testing, while dried blood spot sampling allows screening in people with poor venous access or where trained personnel are not available to carry out blood draws. Dried blood spot sampling has been used extensively for hepatitis C screening in the United Kingdom, France and the Netherlands.

Electronic medical record reminders to screen for hepatitis C can improve screening rates, using age cohort reminders to screen older patients in the United States or risk-based reminders to screen people with hepatitis C risk factors.

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HEPATITIS SA COMMUNITY NEWS 88 • December 2020

Image by by macrovector/Freepik

Decentralised and community-based testing in drugs services not only improves diagnosis but leads to increased engagement in treatment, the review found. Similarly, offering testing in migrant facilities and internment centres can enable engagement in treatment, Italian and Australian models show. Very large-scale

Reference: Lazarus J et al. Hepatitis C standards of care: a review of good practices since the advent of direct-acting antiviral therapy. Clinics and Research in Hepatology and Gastroenterology, 45: 101564, 2021.

community-based testing in Egypt resulted in testing of almost 80% of the population in 2018 and 2019, the reviewers note.

Testing in community pharmacies using dried blood spot testing has achieved high testing uptake among people who inject drugs in London and Scotland and was more likely to result in hepatitis C screening compared to the conventional testing pathway in a Scottish study in people receiving opioid substitution therapy. Mobile testing services, for example through vans which go to locations where they can reach homeless people, drug users and sex workers, have proved successful in Australia, Denmark, Spain and the US.

Treatment and care Providing treatment in non-clinical locations, such as prisons and harm reduction facilities has the potential to increase the numbers treated and engage people who would otherwise be missed by conventional service patterns. Co-ordination between existing health services such as mental health services providing treatment for substance users and hepatitis C programmes can also increase treatment uptake, US research shows. Screening for hepatitis C in tuberculosis treatment programmes re-

sulted in high rates of diagnosis and referral for treatment in Georgia, a country with a high burden of TB. Task-shifting, when medical tasks are devolved to nurses or community health workers, increases capacity to screen for hepatitis C and start people on treatment. A US study found no difference in cure rates according to the medical personnel who were responsible for supervising treatment, showing that a broad range of healthcare workers can provide high-quality hepatitis C care.

Telemedicine can support primary care physicians to provide hepatitis C treatment, linking physicians to specialist support in hepatology, addiction medicine and psychiatry, as they manage hepatitis C patients with complex needs.

Loss to follow-up prior to treatment or during treatment is a major obstacle to hepatitis C elimination. Strategies to promote re-engagement in care are essential. Some studies find a high proportion of those screened for hepatitis C have a previous diagnosis. Reengaging these people in care by identifying their current and previous barriers to care can result in high cure rates, research in the Netherlands shows.

Stigmatising attitudes among healthcare workers are often cited as the reason for avoidance of hepatitis C care. Stigma education programmes for healthcare workers have the potential to improve engagement in care. Peer support in healthcare settings, drugs services and the community is critical for engaging people from marginalised groups in care and overcoming stigma. Peer outreach proved successful in promoting engagement in care in a UK trial, for example.

A need for investment and implementation research

The study authors say that without political will to eliminate hepatitis C and investment in elimination efforts, good practices will not be sufficient to drive the elimination of hepatitis C. Research into the implementation of a combination of good practices, such as point-of care testing, nurse-led treatment initiation and peer support, all delivered in non-clinical services, is needed to demonstrate how good practices can be combined to best effect. v Keith Alcorn Infohep.org

April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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COVID-19 & Hepatitis

COVID vaccination for people living with HBV and HCV

I

of death from the COVID-19 virus.

Researchers have found that while hepatitis C infection does not raise the risk of death from COVID-19, people with hepatitis C with more advanced liver disease were more likely to be hospitalised and admitted to intensive care. Furthermore, those living with decompensated cirrhosis were at higher risk

While there has not been evidence of the COVID-19 virus affecting the liver, experts in the United

f you’re living with hepatitis B or hepatitis C, you are eligible for COVID-19 vaccination under Phase 1b which is currently being rolled out in Australia.

Studies in the United States, published in December 2020, found that people with chronic liver disease were at significantly increased risk for COVID-19, with the strongest effect in those with chronic non-alcoholic liver disease and non-alcoholic cirrhosis, followed by hepatitis C.

Kingdom have warned clinicians not to be complacent about the risks of COVID-19 in patients with chronic liver diseases and cirrhosis because those people have poor immune function and worse outcomes from acute respiratory distress syndrome than the rest of the critically ill population.

Under the Australian Government’s COVID-19 Vaccine Roadmap, people eligible for a COVID-19

Photo CC Wikimedia

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HEPATITIS SA COMMUNITY NEWS 89 • April 2021

vaccination under Phase 1b include those with a specified underlying medical condition, including chronic liver disease.

The ASHM Taskforce on BBVs has recommended that people living with blood-borne virus-related chronic liver disease in Australia who were not eligible for Phase 1a of the COVID-19 vaccine roll-out should be offered a vaccine during the Phase 1b roll-out.

The Taskforce noted that most people with chronic hepatitis B virus (HBV) infection have not been assessed to determine if they have chronic liver disease and are not receiving treatment.

Similarly, a significant number of those with current or prior hepatitis C infection may not have been assessed for chronic liver disease.

For those reasons, the Taskforce recommended that

clinicians assume that chronic liver disease may be present in people living with chronic HBV infection and people with current, or prior, hepatitis C virus infection.

interpreters or appropriate information in the person’s own language are available so that they can give informed consent for vaccination,” the Taskforce said.

It also recommended that authorities consult with hepatitis peak organisations, clinicians and researchers to optimise engagement with the community.

The Taskforce pointed out that Aboriginal and Torres Strait Islander (ATSI) communities too needed special consideration in the delivery of COVID-19 vaccines as they were disproportionately impacted by HBV, with an estimated 16,241 people living with chronic HBV, and twice the rate of liver cancer than in non-Indigenous communities.

The Taskforce further recommended that all people living with blood-borne virus-related chronic liver disease be offered a COVID-19 vaccine regardless of whether they have a Medicare card, including prisoners and those in immigration detention, those on temporary visas and undocumented status.

“Given the high proportion of people from culturally and linguistically diverse backgrounds living with HBV or HCV, it is essential that

If you are living with hepatitis B or hepatitis C, speak to your GP about getting the COVID-19 vaccine.

Read the full ASHM Taskforce statement at bit.ly/ashm-bbvcovidvax. Visit bit.ly/vaxeligibility-checker to check your eligibility. v

Sources: •

Statement from the ASHM COVID-19 Taskforce regarding the Prioritisation of COVID-19 Vaccines for People Living with Blood-borne virus-related Chronic Liver Disease, March 2021

•

Priority groups for COVID-19 Vaccination Program: Phase 1B, 18 March 2021, health.gov.au/sites/ default/files/documents/2021/03/priority-groups-for-covid-19-vaccination-program-phase-1b_1.pdf

•

Hepatitis C does not raise the risk of death from COVID-19, Keith Alcorn, 19 February 2021, Infohep.org

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COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States, Wang Q et al, December 2020, EClinicalMedicine, doi.org/10.1016/jeclinm.2020.100688

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COVID-19 and the liver: little cause for concern, Mansoor Bangash et al, p 529, The Lancet Vol 5 June 2020, thelancet.com/gastrohep

April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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In Memory of Jude Byrne

Remembering a champion and advocate

S

adly, on 5 March this year, Jude Byrne passed away.

In Jude’s passing we lost a truly international champion of harm reduction and a wonderful advocate for drug users’ rights. Jude was instrumental in establishing the Australian Injecting and

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Illicit Drug Users League (AIVL), the national drug user peer organisation, and most recently was the National Coordinator (BBV & STI Peer-Based Policies and Programs) at AIVL. Jude’s outstanding contribution to harm

HEPATITIS SA COMMUNITY NEWS 89 • April 2021

reduction on a global level was formally recognised in 2011, when she was presented with the International Rolleston Award.

Whether Jude was raising awareness about the issues for older drug users, women

who use drugs, people on opioid dependence treatment or people living with hepatitis C, she was always articulate and well informed. Jude could surpass researchers, clinicians, scientists and professors with her knowledge and insight because for Jude it was personal.

her various roles over many years, she delivered education on hepatitis C testing and treatment for the injecting community, as well as stigma and discrimination training for the wider community.

Addressing inequalities and

Jude passionately believed that people who use drugs are entitled to the same human rights as the rest of humanity.

In a statement, the Kirby Institute noted that “Jude was deeply involved in a number of drug user community organisations for over three decades, including AIVL, the International Network on Health and Hepatitis in Substance Users (INHSU), and the International Network of People who Use Drugs (INPUD).

“She was fiercely committed to advocating for the rights and equitable health access of people who use drugs, and was a thoughtful and insightful teacher. Through

championing the human rights for the injecting drug user community was her life’s work, and will remain her legacy.”

An INHSU spokesperson said, “Jude was a globally recognised, powerful advocate who fought to advance the health and human rights of people

who use drugs with her formidable intelligence, honesty and dignity.”

“Jude has been a source of great inspiration to many for decades,” said AIVL’s Mel Walker, “and her legacy will endure, not just through her own enormous contribution to the drug user movement, but also through the many people she has mentored, encouraged and influenced throughout her career who have gone on to make their own very important contributions across the BBV/STI, AOD and related health and social justice fields.”

Jude’s passing may have left the international harm reduction community reeling but it was Jude’s contribution to harm reduction and drug users’ rights throughout her life that will be remembered and acknowledged for many years to come.

Vale Jude Byrne. v Carol Holly

April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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Testing… Testing…

New technology for easier HCV testing

H

epatitis C tests are getting easier. That’s the promise on the horizon as new testing methods are introduced or trialed.

Current conventional hepatitis C testing consists of a blood test for hepatitis C antibodies, followed by a PCR test for the hepatitis C RNA, if the antibody test comes back positive. There is the usual waiting period of a week or more after each test.

For busy people or transient populations, that poses a challenge. Others are put off by the need to draw blood.

transgender history, people from African, Asian or other countries where HIV is more common, and people who have current or previous sexual partners from Africa or Asia.

New testing methods being introduced, piloted or trialed include dried blood spot test, point of care finger prick blood test and point of care oral tests.

Dried Blood Spot test

Under a new initiative in New South Wales, free Dried Blood Spot (DBS) test kits for HIV and hepatitis C are available to anyone living in the state over the age of 16. The DBS test offers an easy, private way to be tested.

The DBS HIV test is for men who have sex with men, people with a

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HEPATITIS SA COMMUNITY NEWS 89 • April 2021

The DBS hepatitis C test is for people who identify as Aboriginal or Torres Strait Islander, people who have ever injected a drug, people who have ever been in prison, or people from countries

OPPOSITE: A guide to the NSW DBS test process RIGHT: The SD Bioline kit for finger prick tests BELOW: A diagnostic system for analysing finger prick tests

where hepatitis C is more common.

People who think they may be at risk of HIV or hepatitis C can order the test online after completing a risk assessment questionnaire. The test kits can also be picked up from selected health services. You don’t need to go to a clinic or see a doctor to do this test.

The DBS test consists of putting a few drops of blood from a finger onto a test card, leaving it to dry and posting it in for testing. Results are available in a week and may return as “negative”, “detected” or “invalid”.

Negative results are delivered via text, email or a phone call.

People with “detected” results will be contacted by text message or email to follow up with a nurse to arrange for further testing to confirm the results.

very small number of tests give false positive results, this can be clarified through further testing.

Point of Care finger prick tests

Other hepatitis C tests that have been developed and which are currently being trialed in Australia are the SD Bioline test which detects hepatitis C antibodies and the GeneXpert Diagnostic System which tests for hepatitis C RNA. Both tests use small blood samples from finger pricks.

The PROMPt study by EC Australia, currently underway in South Australia uses these two tests to screen and test for hepatitis C in selected target communities.

Participants receive pre-test counselling, get the hepatitis

C antibody test and if that returns a positive, receive the hepatitis C RNA test. Those who return a positive for hepatitis C RNA can then be counselled and referred for follow up and treatment.

Eliminate hepatitis C Nurse Consultant, Lucy Ralton, explains that the SD Bioline test takes a minimum of five minutes to return a result for the HCV antibody.

“It works like a pregnancy test, one line equals negative, two lines equals positive. In the PROMPt project, people who receive a positive antibody test then do an HCV PCR test using a finger prick blood sample and receive the results for this test in approximately 60 minutes,” she says.

“The SD Bioline test detects the presence of HCV

An “invalid” result means the test did not work and participants will need either another DBS test or a conventional test to determine their HIV and hepatitis C status.

According to the NSW Health, DBS tests are overall, very accurate with close to 100% accuracy; and while a

April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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antibodies and GeneXpert HCV test measures real time viral load, from 110 – 100,000,000 HCV RNA IU per mL. The lab-based PCR test is slightly more sensitive.”

“At this stage no TGA submission has been made for Abbott’s SD Bioline HCV antibody test which is used widely internationally and was accepted for the WHO prequalifying list of in vitro diagnostics in 2016.

“This is due to the significant cost involved in making a TGA submission and the lack of reimbursement for this test. We hope that PROMPt data may assist with future advocacy in this space.

“The GeneXpert HCV viral load assay test received TGA approval in May 2020 and is in use in several locations with the support of pharmaceutical companies, but to my knowledge access isn’t widely available.”

According to NC Ralton, Cepheid’s GeneXpert diagnostic systems can be programmed to run many

different tests including for various infectious diseases such as COVID-19. Several Aboriginal Community Controlled Health Services now use the Genexpert system for COVID 19 Point of Care Tests across Western Australia, Northern Territory, Queensland and South Australia under a Federal government grant awarded to the Flinders University and the Kirby Institute.

The different methods offer different advantages that suit different situations. DBS makes it possible for people to get the test in private. It is a useful way to encourage more people to be screened and to identify those who need further tests or follow up.

Point of Care testing with on-the-spot results has the advantage of immediate follow up reducing the number of people lost to the system.

Oral tests

In addition to DBS and Point of Care finger prick tests, researchers overseas are

looking at new point-ofcare hepatitis C antibody tests using oral fluids, both researcher-administered and self-administered. Results for these have been promising accurately identifying 92% positive results and up to 98% negative results.

These tests represent new tools for universal hepatitis C screening to identify people who are infected, especially useful in regions with limited medical resources.

In Australia, it is estimated that one in five people who have hepatitis C do not know they have it. As we work towards hepatitis C elimination by 2030, it’s become clear that unless testing and diagnoses increase, there will be thousands missing out on the chance of a cure before serious disease develops.

Simple accessible tests like DBS testing and finger prick point of care tests will help to reach more of the undiagnosed. v Cecilia Lim

Sources: •

dbstest.health.nsw.gov.au

•

Dried Blood Spot Test Information Sheet version 3.0, 30 June 2020, www.dbstest.health.nsw. gov.au

•

Evaluation of a new point-of-care oral anti-HCV test for screening of hepatitis C virus infection, Liu et al, Virology Journal (2020) 17:14

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HEPATITIS SA COMMUNITY NEWS 89 • April 2021

Eating In

Good food for prisoners (and everybody else!)

W

hen I was a prisoner in mainstream, I was surviving mainly on fruit and toast.

The reasons for that were complex, but the upshot was when I transferred to prerelease and allowed to cook for myself, I realised that I hadn’t actually cooked a meal in at least five years!

The last time I had any relationship with food before that was when I worked as a short-order cook after (almost) completing a prevocational commercial cookery course at Adelaide TAFE. My lifestyle at the time ensured that I didn’t complete that certificate.

I couldn’t recall the last time I had cooked an actual meal for myself. My chaotic life had put food very low down on my list of priorities for many years.

My food preparation experience acquired through various jobs was enough for me to cook the basics, but the limited ingredients, my restrictive budget and limited cooking utensils at the Adelaide Pre-release Centre (APC) back then meant that I continued to live mostly on fruit and toasties.

I looked for inspiration in recipe books and magazines available around the APC but most of them required at least one ingredient that was unavailable, and ingredient quantities were usually given in grams or ounces – there was no way of working out the correct conversion into cups or tablespoons which were the only measuring equipment that we had in our cottage.

For about five years after my release, I worked really hard to make positive changes in my life. I kept to myself, ignored previous friendship groups, changed my phone number and slowly reduced off pharmacotherapy. Each

April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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day I became more confident that I wouldn’t relapse.

I had few skills and a criminal record and was unsure what to do with my life, other than to be a better parent to my child, who was by then just starting school. Still unsure of what I would like to do for a job, I sat for adult entry to university to get some kind of qualification and enrolled into a Bachelor of Arts at Flinders Uni which provided the broadest range of courses for someone like me who still didn’t know what they wanted to be when they grew up.

I was drawn most to criminology and sociology but while the subjects were interesting on paper I felt I needed practical experience.

I applied, and was accepted, to work as a volunteer at an organisation which supported prisoners and their families.

After proving myself a reliable and motivated volunteer for 12 months, I was offered a job which included providing hepatitis C transmission and prevention information to prisoners and their families.

It was in this role that I once again came across the challenges of cooking while inside prison, though this time it was from the outside.

Prisoners I had contact with

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would ask for recipe books, reminding me that most of the recipes in magazines called for wine or other ingredients that they could not get.

Today, after five years in that first organisation, followed by nine years as a drug and alcohol counsellor, and during all those years undertaking lots of professional development (certificates, qualifications and training), I work with Hepatitis SA as a peer coordinating their support program for the community.

Part of my work takes me back to prisons, talking to people about hepatitis, its effects on the liver and their health, how to protect themselves from it, how to look after their liver and sharing my lived experience with hepatitis C. When we talk about liver health, the discussion invariably turns to healthy eating, and I am again reminded of the limitations and challenges of cooking inside.

While speaking with prisoners at the Adelaide Prerelease Centre about hepatitis C I was asked if we had any recipe books. I have our liverfriendly recipe book Eat Well for Your Liver but, again,

HEPATITIS SA COMMUNITY NEWS 89 • April 2021

many of the ingredients are not available unless prisoners can afford to do a special buy.

That was something I could not afford when I was in there; no doubt there will be many others like me.

The result is the Eating In recipe book, coming soon from Hepatitis SA. Tailored for people in South Australian prisons who are allowed to cook for themselves, Eating In presents recipes that have been specially selected for people who self-cater on the inside. All of the ingredients included in each recipe are currently available on the Adelaide Pre-Release Centre “Provisions Order Form”.

We received recipe contributions from Hepatitis SA staff and the community, including members of the Local Exchange and Trading System (LETS). Many of the recipes were tested by prisoners who told us what they thought of them and what they would like to see more of in the book. Happily the feedback was 100% positive!

Eating In will be available soon. For more information on food and liver health, visit hepsa.asn.au. v Lisa Carter

Zucchini Slice Makes 6-8 serves

Ingredients • 2 zucchini • 1 large onion • 3 rashers of bacon • 6 eggs • 1 cup (about 100g) tasty cheese • 1 cup of self raising flour • 1 teaspoon of margarine, butter or vegetable oil For a vegetarian version, leave out the bacon and add a little more cheese

FROM

Method Pre-heat oven to 170°C. Finely chop onion into 1cm cubes.

Finely chop bacon.

Fry the bacon and onion until slightly brown.

Grate the zucchinis.

Grate the cheese.

In a large mixing bowl, beat the egg with a fork until the white and yolk are thoroughly combined.

Add the cheese, zucchini, flour, bacon and onion to the eggs and mix together thoroughly.

Grease a loaf tin or baking dish with the margarine, butter or oil so that the mix won’t stick to it during the baking process.

Pour the mixture into the loaf tin or baking dish.

Place in the preheated oven for 35-40 minutes.

Serve hot or cold.

“You can eat this hot or cold. I used to cook this but forgot the recipe, so it was great to be able to cook it again. It is one of my faves.”

—Nicole

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April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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Hepatitis Transmission via Body Art V

arious forms of body art practices are becoming increasingly widespread: tattooing, piercing, scarification and implants, to name a few.

But, as with any procedure where blood is present, these forms of body modifications can carry a high risk of infection.

There is a wealth of information available on how to ensure your health and safety is protected if you are considering any of these procedures – our library has links to a range brochures, factsheets, and videos. All are free to access online: please contact us if you have any problems with this (admin@hepsa. asn.au).

Here’s how to find information via our catalogue – with some examples of what is available.

Here are some examples of what you can access via the catalogue: Body art and hepatitis C Hepatitis SA, Adelaide, 2015. 3 fold brochure. bit.ly/3fbceE6 Some questions to ask the tattoo artist or body piercer before getting work done along with some general info about risks. Available online as read only: contact Hepatitis SA for free hard copies (admin@ hepsa.asn.au).

From the library home page at hepssa.asn.au/library:

• click on the green search catalogue link at the top of the page • from the catalogue page: click on browse topics • have a look at the Australian Community Resource list • open the Transmission heading to find the Body Art link.

This link will open all of the available resources: check out the listings on the left hand side of the page to narrow down your results (by sub topics, format, author etc).

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HEPATITIS SA COMMUNITY NEWS 89 • April 2021

If tatts could talk (the whole story - getting a safe tattoo or piercing) Hepatitis Australia, Canberra, 2020. Video 1.26 mins, 2p info. bit.ly/2Put9GT If you go to a professional tattoo or piercing studio in Australia, your chances of getting hepatitis B or hepatitis C are almost nil. However, backyard tattoos and overseas shops could put you at risk.

Skin penetration procedures: client information for ear piercing, body piercing and other skin penetration processes

by Health Vic, Melbourne, 2019.

2p. factsheet bit.ly/skinpenetration Client information for ear piercing, body piercing and other skin penetration processes including risks (infection, allergic reactions, nerve damage or transmission of serious infectious diseases), aftercare, and what to look for in a practitioner.

Hepatitis C Self-Assessment Guide Hepatitis SA , Adelaide, (undated).

Online interactive quiz. bit.ly/3smdlEX This simple 5-minute quiz assesses personal risk factors for hep C (including body art).

Results are confidential and can be printed out to take to GP for follow up.

You don’t wanna mess with me ; Together we are strong Centre for Culture, Ethnicity and Health, Melbourne, (undated). 2x videos: 4 mins, 6 mins. bit.ly/dontwannamess

You Don’t Wanna Mess With Me: This street art-inspired animation takes you on a journey inside and outside the human body. Using a hip hop song written and performed by young men in custody, it presents key information about hep C including tattoos.

Together We Are Strong: Made for prisoners by prisoners, this animated film travels from a remote Vietnamese village to the streets of Melbourne, into prison and out again, outlining the risk factors for hepatitis (in Vietnamese with English subtitles).

Let us know if you would like to know more about transmission risks.

The library can give you information about additional resources (contact us on admin@hepsa.asn.au), the From ‘Little Hep Info Line can talk to you via B Hero’ phone (1800 437 222), or you can ask questions online via Purechat on our homepage at hepatitissa.asn.au.

hepatitissa.asn.au/library April 2021 • HEPATITIS SA COMMUNITY NEWS 89

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Calming the C E NEED FOR • Information and support in a confidential, TH D N A 9 -1 ID V CO O T DUE friendly environment CALMING THE LL A , G N CI N TA IS D L SOCIA • Speak to others who have had SPENDED SUtreatment BEENwelcome E friends HAV SSIONS • Partners, family and C SE OTICE: UNTIL FURTHER N 7 222 Please ring 1800 43 ation for hepatitis inform

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Hutt Street Day Centre: 258 Hutt St, Adelaide SA 5000; call Margery on 0423 782 415 to make an appointment • Information and support friendly environment • WestCare Services: 11/19 19 DVI CO TO E DU • Speak to others Millers Ct, Adelaide SA 5000;who hav R 415 FO Partners, and frien call on ED 0423 family 782 THE• NE DMargery AN , to make an appointment NG SOCIAL DISTANCI •

Now meeting at HACKNEY, ELIZABETH and PORT ADELAIDE Call Us! For information, phone 8362 8443 Free, confidential information See over for dates and support on viral hepatitis:

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Free Fibroscan Clinics

CLINIC Wonggangga L LIVERTurtpandi AL Aboriginal Primary Health SESSIONS HAVE Care Service (Pt Adelaide meeting ENDEDat HACKN SP SU EN1Now st BE CNP); Wednesday of each and PORT ADE L FURTHE month, amR , 11 UNTI9.30–11.30 ChurchNO St, For Port Adelaide SA : TICE information, phon 5015

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ring See over for

e Pleas Anglicare Elizabeth Mission; 7 22 18001443 17 April, Aug, 132Nov, 9.30am –12 pmpa , 91-93 titisElizabeth he for Way Elizabeth (Bookings via mation for in reception in person, or call 8209 5400) Noarlunga GP Plus; fortnightly, Alexander Kelly Dr, Noarlunga Centre SA 5168 (Bookings via Noarlunga CNP

A Note to Our CNP Clients We are approaching the COVID-19 pandemic with an abundance of caution in line with the recommendations of health experts.

We ask that you arrange for someone else to collect your equipment, if you have • any flu-like symptoms such as fever and cough, or • recently returned from travel overseas.

When collecting equipment, we ask that you cooperate with ‘social distancing’ recommendations:

16

HEPATITIS SA COMMUNITY NEWS 89 • April 2021

• 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!

December 2020 • HEPATITIS SA COMMUNITY NEWS 88

11

g theUseful C Services & Contacts Hepatitis SA

t in a confidential, Free education sessions, printed

information, telephone information

ve had treatment and support, referrals, clean needle nds welcomeprogram and library.

(08) 8362 8443 admin@hepatitissa.asn.au www.hepsa.asn.au

NEY, ELIZABETH Hepatitis SA Helpline ELAIDE 1800 437 222 (cost of a local call) ne 8362 8443 Adelaide Dental Hospital dates A specially funded clinic provides

priority dental care for people with hepatitis C with a Health Care Card.

Call Hepatitis SA on 1800 437 222 for a referral. beyondblue Mental health information line

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

Nunkuwarrin Yunti An Aboriginal-controlled, citybased health service, which also runs a clean needle program.

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

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

Lifeline National, 24-hour telephone counselling service.

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

13 14 65

1300 224 636 www.beyondblue.org.au

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

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

(08) 8223 4566

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

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

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

(08) 8406 1600

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

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

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

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

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

Debbie - 0401 717 953

North: Bin - 0401 717 971 bin.chen@sa.gov.au

Michelle - 0413 285 476

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

Jeff - 0466 777 873

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

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

Free Blood Safety + Viral Hepatitis Professional Development via

Sessions cover: • Blood and bodily fluid safety • An overview of hepatitis A, B and C • Transmission risks/myths (including issues like needle-stick injury) • Testing and treatments • Best practice after blood exposure • Standard precautions • Stigma and discrimination • Disclosure • Available Services

Cost: Free Duration: 1 hour How to book: Contact education@hepsa.asn.au 2

HEPATITIS SA COMMUNITY NEWS 89 • April 2021

Blood cell image byFreepik/Macrovector

Book your online education session.

All you need is internet access.