#93 HepSA Community News

Community News

#93 • March 2022

The Prehistory of Hep B Plus Finding 50,000 and more

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

ISSN 2651-9011 (Online)

Online: www.hepsa.asn.au HepSAY Blog: hepsa.asn.au/blog Library: hepsa.asn.au/library @HepatitisSA @hep_sa Resources: issuu.com/hepccsa Email: admin@hepatitissa.asn.au Cover: (derived from an image by Cobija) The Urfa Adamı, the first full-sized human statue, carved roughly 11,000 years ago, when hepatitis B was already living in humans (see p4) Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email editor@hepatitissa.asn.au.

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

This resource was prepared and printed on Kaurna Country

Contents

1 It’s Your Right 2 Finding 50,000 4 Prehistory of Hep B 6 Paul Harvey 8 Naloxone Take-Home Pilot 10 HCV Testing in Pregnancy 11 Kirby Institute 12 Antihistamines vs Liver Cancer 13 What’s On? / CNP Info 14 In Our Library Disclaimer: Views expressed in this newsletter are not necessarily those of Hepatitis SA. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist.

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

SA Health has contributed funds towards this program.

It’s Your Right

Promoting testing and treatment for people who inject drugs

T

he Eliminate Hepatitis C Australia Partnership (EC Australia) was created in 2018 to bring together researchers, implementation scientists, government, health services and community organisations to work toward eliminating hepatitis C as a public health threat in Australia by 2030.

EC Australia’s goals: •

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Ensure that 15,000 Australians with chronic hepatitis C are treated and cured of their infection annually Ensure that people identified with cirrhosis related to hepatitis C infection are treated and cured, and regularly reviewed to monitor for liver cancer

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Establish a national collaborative framework to facilitate a coordinated response to the elimination of hepatitis C as a public health threat from Australia by 2030.

The forthcoming EC Australia “It’s Your Right” Health Promotion Campaign, which launches in April, aims to reduce the prevalence of hepatitis C amongst people who inject drugs by using peer engagement to increase access to hepatitis C testing and treatment.

EC Australia and AIVL member organisations and programs are working together to roll out the campaign nationally. We want to reach people who currently inject, who are not

accessing hepatitis C testing and treatment services, and who may be delaying and/ or avoiding treatment. The campaign aims to shift perceptions about treatment and support people to prioritise treatment for hepatitis C. The funding for the campaign is from the Paul Ramsey Foundation and is administered by EC Australia at the Burnet Institute.

The It’s Your Right Campaign will feature street advertising, NSP posters, merchandise, giveaways, short films and peer outreach activities over a 3-month period, starting in April. Visit the www.itsyourright.com.au website for more information soon! v

www.itsyourright.com.au March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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50,0 Finding 50,000

National project to increase HCV treatment rates

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hunt will soon be on to find 50,000 Australians with hepatitis C who are missing out on getting cured.

The ‘Finding 50,000’ campaign will target geographically dispersed and socially diverse people who so far, have not been reached by the “business-as-usual” national hepatitis C response.

Led by Hepatitis Australia and funded by the Federal government as part of a larger project, ‘Finding 50,000’ will work with local services and communities to engage with 50,000 people with hepatitis C by the end of 2022.

Geo-targeting

This geo-targeted campaign will be implemented in 16 areas nationally. State and Territory Health Departments have been asked to identify Primary Health Network (PHN) areas as targets for on-the-ground implementation. These are areas:

•

which are not already being targeted in other campaigns or projects.

By focusing on specific locations, activities can be integrated, and by selecting locations where there is capacity to scale up services, the impact of the campaign can be maximised to increase hepatitis C testing and treatment.

The 16 geographic areas include four in New South Wales, three each in Queensland and Victoria, two in Western Australia and one each in the ACT, Northern Territory, South Australia and Tasmania.

SA: A Granular Approach

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where testing and treatment uptake are low,

South Australia has just two PHNs, both of which have relatively high hepatitis C treatment uptake. SA Health has therefore adopted a more granular approach by identifying Australian Bureau of Statistics sub areas (SA3) within the Adelaide PHN as target locations.

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which are unlikely to reach the national 2022 targets without additional effort, and

Four metropolitan SA3 regions—Port Adelaide – West, Port Adelaide – East, Playford and Salisbury—were

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

recommended. The four areas are over-represented in the number of people with untreated hepatitis C.

In making the recommendations, Tom Rees, Manager STI & BBV Section, SA Health, said that the most recent Viral Hepatitis Mapping Report showed that in 2020 these four SA3s contained 21% of the overall South Australian population, and 34% of all South Australians living with hepatitis C who were yet to access treatment.

He further pointed out that postcodes with lower socioeconomic indices have higher hepatitis C notifications, quoting a study into the socioeconomic burden of hepatitis C in SA which stated that “HCV notifications were 7 times more likely to be from people residing in the least economically-resourced 10% of postcodes, and 20 times more likely compared to people living in the wealthiest deciles”.

The SA3 of Port Adelaide – East, Port Adelaide – West, Playford and Salisbury are also served by existing services which can be scaled

000 •

up to meet increased demand for hepatitis C testing and treatment.

The Larger Project

The campaign is a component of the larger National Hepatitis C ‘Finding 50,000’ Campaign, also known as the 50,000 Project.

The 50,000 Project is a sector-led proposal developed following a commitment made by Federal Minister for Health Greg Hunt in November 2020, to find 50,000 people living with hepatitis C by the end of 2022 as part of the response to achieve Australia’s hepatitis C testing and treatment targets.

The Project identified five key “inter-related and mutually reinforcing” pillars of activities to be focused in areas where testing and treatment uptake have been low, and concerted effort is needed. The activities are: •

national hepatitis C public education campaigns,

a national program to increase hepatitis C point of care testing,

•

expanded hepatitis activity in primary care, including case finding,

•

national Hepatitis C Infoline enhancement,

•

a hepatitis C systems working group and project coordination and evaluation

It is projected that, run concurrently, these activities will amplify the reach and retention of messages, and increase community engagement in local existing services.

Local Activities

Running under the umbrella of the broader campaign, ‘Finding 50,000’ will organise events and work with communities to motivate people to act on hepatitis C. It aims to achieve this by working with community influencers, raising awareness within communities, about hepatitis and liver cancer, and providing people with support and pathways to

seeing friendly nurses and GPs to get tested and treated.

These activities will be further reinforced with messages in the media, and be supported by other national 50,000 Project activities including enhancement of the Hepatitis Infoline, point-of-care testing, campaigns with people who inject drugs, and work with Aboriginal and Torres Strait Islander communities, as well as the national and individual state World Hepatitis Day campaigns.

The National Hepatitis C ‘Finding 50,000’ Campaign is funded by the Australian Government Department of Health. Project partners include the Australian Department of Health & BBV & STI Standing Committee, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), Hepatitis Australia, The Burnet Institute in partnership with NACCHO and AIVL, The Kirby Institute in partnership with Flinders University and National Reference Laboratory. v

Cecilia Lim

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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The Prehistory of Hep B 10,000 years of HBV and humans

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new study has traced the evolution of the hepatitis B virus (HBV) from prehistory to the present, revealing dissemination routes and changes in viral diversity.

In a new paper in the journal Science, researchers uncover the evolution of HBV since the Early Holocene (roughly 12,000 years ago, when the human species began to dominate the globe) by analysing the largest dataset of ancient viral genomes produced to date.

Present-day HBV strains are classified into nine genotypes, two of which

are found predominantly in populations of Native American ancestry.

Coming to the Americas

The study provides strong evidence that these strains descend from an HBV lineage that diverged around 11,700 years ago, and was carried by some of the first inhabitants of the Americas.

“Our data suggest that all known HBV genotypes descend from a strain that was infecting the ancestors of the First Americans and their closest Eurasian relatives around the time these populations diverged,” says Denise Kühnert, supervisor of the study. Kühnert is head of the Transmission, Infection, Diversification and Evolution (TIDE) Group at the Max Planck Institute for the Science of Human History in Germany.

HBV in prehistoric Europe

The study also shows that the virus was present in large parts of Europe as early as 10,000 years ago, even before the spread of agriculture to the continent.

The spread of human populations in the years before present (BP), based on 918 sites (circled) in Europe and the Near East.

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

“Many human pathogens are thought to have emerged

Illustration courtesy of the Royal Society [royalsocietypublishing.org/doi/10.1098/rsif.2015.0166]

In the 21st Century, HBV causes close to one million deaths each year. Recent ancient DNA studies have shown that the virus has been infecting humans for millennia, but its past

diversity and dispersal routes remained largely unknown.

The new study conducted by a large team of researchers from all around the world provides major insights into the evolutionary history of HBV by examining the virus’ genomes from the remains of 137 ancient Eurasians and Native Americans who lived at various times between 10,500 and 400 years ago.

The study’s results highlight dissemination routes and shifts in viral diversity that mirror well-known human migrations and demographic events, but also show unexpected patterns and connections to the present.

Geographic distribution of ancient HBV genomes within different time-periods, coloured by lineage. (BP = Before Present)

herding populations around 5,000 years ago, which dramatically altered the genetic profile of Europeans—but, strangely, was not associated with the spread of new HBV variants.

Collapse and Reappearance

Illustration courtesy of Science [www.science.org/stoken/author-tokens/ST-161/full]

One of the most surprising findings of the study is a sudden decline of HBV diversity in western Eurasia during the second half of the 2nd millennium BC, a time of major cultural shifts, including the collapse of large Bronze Age state societies in the eastern Mediterranean region.

“This could point to important changes in epidemiological dynamics over a very large region during this period, but we will need more research to understand what happened,” says Arthur Kocher, lead author and researcher in the TIDE Group.

after the introduction of agriculture, but HBV was clearly already affecting prehistoric huntergatherer populations,” says Johannes Krause, director of the Department of Archaeogenetics at the Max Planck Institute for Evolutionary Anthropology and co-supervisor of the study.

After the movement of people from the Near East to Europe, the HBV strains

carried by hunter-gatherers were replaced by new strains that were likely spread by the continent’s first farmers, mirroring the large genetic influx associated with the expansion of farming groups across the region. These new viral lineages continued to prevail throughout western Eurasia for close to 4,000 years. The dominance of these strains lasted through the expansion of western

All ancient HBV strains recovered in western Eurasia after this period belonged to new viral lineages that still prevail in the region today. However, it appears that one variant related to the previous pre-historic diversity of the region has persisted to the present.

This prehistoric variant has evolved into a rare genotype that seems to have emerged recently during the HIV pandemic, for reasons that remain to be understood.

There is still a lot to learn about the long history of humans and hepatitis B. You can read the full study online at bit.ly/3HIhnin. v

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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Happy Retirement, Paul Harvey H

epatitis SA bids a fond farewell to Paul Harvey, Information and Communication Manager at Hepatitis NSW, after 28 years in the sector. Many of Hepatitis SA’s members and readers of Hepatitis SA

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Community News will remember that Paul was responsible for producing the excellent Hep Review, which Hepatitis NSW kindly allowed us to distribute in South Australia.

HEPATITIS SA COMMUNITY NEWS 93 • March 2022

Many people living with hepatitis C in SA

will also remember Paul as the driving force behind the online support forum HepCAustralasia.

Before Paul retired at the end of January 2022, Hepatitis Australia asked Paul about his experiences at Hepatitis NSW: “Way back in the early 90s, I surprised myself by getting involved in a community group. I’d been living a

bohemian and rather aimless life (lots of immediate pleasures but not a lot of commitment or direction), and I quickly realised and enjoyed a feeling of anchoring from the support group.

We were a disparate group of people here in Sydney, initially around a dozen, and we leaned on each other’s skill sets.

“I discovered personal skills which included creating documents: how-to guides for volunteer phone workers and producing newsletters.

Other people worked with interstate collaboration, fundraising, media and volunteer recruitment and management. Our community group was a fertile petri-dish and we quickly grew and expanded our activities. It all seemed very exciting to me.

“Our early milestone events seem very clear: we gained funding from NSW Health, a seeding grant; we secured our first office, a temporary room in a commercial building; we employed our first CEO, Stuart Loveday, a move that set us up for decades to come.

Other milestones were less obvious. Whether it was individual medical specialists or professional bodies, local health districts, Sydney City, South Sydney or other LGA councils, other States and Territories, nursing, AOD

Hepatitis NSW’s videos can be viewed at bit.ly/3rTFN3i and NSP networks, we would work with almost everyone who shared our path or had mutual goals.

“My work as a person with lived experience and as a speaker was always tinged with feelings of vulnerability and fears around stigma. It was about a mixture of low self-esteem and fear of scrutiny or criticism; traits that played some role in my contracting hep C back in the 1980s.

“With Hepatitis NSW I didn’t see myself as a confident or clever public speaker, but others—effective and engaging speakers—did exist, and they played valuable roles while I tended to avoid the limelight. Perhaps our most effective speakers were our Community Mobilisation Volunteers. These stars were recruited in the lead up to 2016 and they worked hard building community action in their local regions across NSW always with an eye on their local politicians and media.

“Looking back on 28 years of work in this sector, there is much that I am proud of.

There is our sheer volume of output. I remember working

closely with Stuart Loveday, putting in long days, often working overnighters to meet so many deadlines. On the specifics side of things, in addition to the past Hep Review magazine, I am very proud of the recent ‘Triffids’ hep C cures video and the current ‘Cold Chisel’ hep C cures video [see image above].

These are projects that were hugely enjoyable in a creative sense and I’ll remember them fondly.

“But there is an oft-forgotten project: the HepCAustralasia online support forum, which up until 2016 was an integral part of our online presence.

It is hard to over-emphasise the impact that the forum had on the Australian and New Zealand hep C landscape.

Over a decade, it supported thousands of individuals through the difficult pre-DAA years of hepatitis C. ‘Newbies’ became members; some became moderators; some became conference speakers.

It was a pleasure and honour to work with the dedicated team of people, all volunteers, who built and maintained an incredibly vibrant healing and supportive environment.”. v

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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Naloxone Success Story Evaluating the Take Home Pilot

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s we reported in issue 91 (see issuu.com/ hepccsa/docs/hcn91/14), the Australian Government funded a Take Home Naloxone (THN) Pilot as part of the Pharmaceutical Benefits Scheme (PBS), allowing people at risk of experiencing or likely to witness an opioid overdose to access naloxone without

a prescription, at no cost to themselves, and from a range of pharmacies and other approved sites in NSW, SA and WA. In September 2019, the Institute for Social Science Research at the University of Queensland began an evaluation of the pilot scheme to inform policy and practice in preparation

for a potential national rollout of THN. The evaluation findings, covering the implementation of the pilot scheme from its commencement on 1 December 2019 up until 30 June 2021 (though the pilot is intended to continue until 30 June 2022), are extremel;y positive.

Improving Access

• More occasions of naloxone supply were recorded: 27,955 supplies over 18 months of the Pilot compared to 3,579 supplies through the PBS in the previous 2 years.

• 1,480 sites registered for the Pilot but only 846 (57%) provided THN during the evaluation period; the active participation rate for other authorised providers was higher (82.5%) than that of community pharmacies (52%).

• More settings provided THN; pharmacies, specialist alcohol and other drug (AOD) services, justice and correction settings, and general health services such as hospitals.

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

• The majority of nonpharmacy THN sites were providers of AOD services; specialist pain clinics did not engage with the Pilot.

• More people received naloxone during the Pilot, both at risk of experiencing opioid overdose and people who may witness an overdose. Most identified as using prescribed opioids.

• The proportion of people at risk from pharmaceutical opioids who received naloxone increased from 0.15% to 1.63%.

• Consumers accessed naloxone close to home, 55% within their home postcode, and THN was available in city, regional and very remote areas.

Improving Uptake • More naloxone was provided to individuals: 43,212 units of THN were supplied in NSW, SA and WA during the Pilot, compared to 4,495 across Australia over the preceding 4 years

• Nasal spray comprised 84% of THN supplied and was the preferred formulation,

but pre-filled syringes remained in demand, particularly for refills.

• Having naloxone accessible at services outside the AOD sector (e.g., community pharmacies) provided opportunities to raise awareness of overdose risk among people who did not use illicit opioids but were themselves at risk or likely to witness another person’s overdose.

• One in five people who received THN refilled their supply at least twice in a year; 65% of refills were due to use to reverse an overdose.

• The Pilot has enabled at least 1,649 overdose reversals, the equivalent of 3 reversals per day.

In some areas, the pilot program did not fully achieve all its original intentions, due in part to the challenges of rapidly scaling up existing operations with limited resources, and due to an initial focus solely on the

alcohol and other drug sector.

There were also significant challenges in attempting to implement a major new health initiative in the competing environment of the COVID-19 pandemic.

Even with these drawbacks, however, the results are commendable.

The Institute for Social Science Research evaluation strongly recommended that Take Home Naloxone be expanded and extended into an ongoing national program that forms an integral part of Australia’s opioid safety net.

There is an established need to address the significant and ongoing risks of opioid overdose, and this is an excellent opportunity to include an evidence-based and effective intervention.

There is a strong impetus among the health sector to implement such a program.

The significant learnings from this pilot program should be taken forward, and the opportunity to continue learning from it ensured. v

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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HCV Pregnancy Tests

Universal hepatitis C screening in pregnancy improves US case detection

I

mplementing universal testing for hepatitis C during pregnancy improved case detection 7.5-fold compared to the previous regime of riskbased screening, a research group from the University of Pittsburgh reported in February at the 2022 Conference on Retroviruses and Opportunistic Infections (CROI).

Hepatitis C prevalence among pregnant women in western Pennsylvania doubled between 2006 and 2016, from approximately 1% to over 2%. Increased prevalence of hepatitis C among pregnant women in Pennsylvania is a consequence of the opioid epidemic, said Dr Catherine Chappell of the University of Pittsburgh.

Screening for hepatitis C in pregnancy can enable early diagnosis before progression to cirrhosis and also prevent transmission of hepatitis C to the infant (the vertical transmission rate of hepatitis C is around 5%). Women receiving perinatal care are

likely to be more motivated to test and remained engaged in care.

In the United States, recommendations for hepatitis C screening began to move from a risk-based screening approach to universal screening from 2018, when the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommended screening of all pregnant women. Other bodies have subsequently reinforced this guidance, but it is not being implemented in all settings.

Reluctance to adopt universal screening is partly a consequence of a lack of evidence regarding prevention of vertical transmission, as well as the absence of clearly defined referral pathways in antenatal clinics for maternal hepatitis C treatment.

The University of Pittsburgh Medical Center began to implement universal screening for hepatitis C during pregnancy in June 2020.

Chappell C et al. Universal hepatitis C virus screening in pregnancy: the juice is worth the squeeze. Conference on Retroviruses and Opportunistic Infections, abstract 37, 2022.

Story originally published at infohep.org/page/3550609

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

Dr Chappell presented a comparison of hepatitis C screening and case detection during periods of risk-based and universal screening in western Pennsylvania. The risk-based screening period chosen for analysis was 2019; the universal screening period ran from 1 July 2020 to 30 June 2021.

During the risk-based screening period, 12,142 women entered prenatal care. The study population was 19% Black, 72% White and 2% Hispanic. Just under half (46%) were covered

by Medicare or Medicaid health insurance. During the universal screening period, 12,558 women entered care.

Seventeen per cent were Black, 74% White and 2% Hispanic; 45% had Medicare or Medicaid insurance.

Screening rates increased from 21% during risk-based screening to 81% during universal screening. The rate of confirmatory HCV RNA test also increased, from 22% to 95%, as a consequence of the use of reflex testing (automatically performing an HCV RNA test on any sample that has shown a positive HCV antibody result). During the risk-based screening period, eleven women were diagnosed

Kirby Institute Evaluation funding for testing

with chronic hepatitis, a prevalence of 0.091%. During the universal screening period, 85 women were diagnosed with chronic hepatitis C, a prevalence of 0.68%.

It wasn’t possible to link to infant health records in this study, so the researchers estimated the number of infant hepatitis C cases based on a published transmission rate of 5.8%.

They estimate that one infant with hepatitis C would have been identified as a result of risk-based screening of mothers, compared with five as a consequence of universal screening.

“Universal screening resulted in a 7.5-fold increase in the detection of chronic hepatitis C,” Dr Chappell concluded.

To establish a successful test-and-treat strategy for hepatitis C in pregnancy, universal screening during pregnancy needs to be accompanied by substance use treatment and hepatitis C treatment, she said.

Australia does not routinely screen for HCV during pregnancy, and this research suggests changing this would be valuable. v Keith Alcorn Infohep

P

rofessor Jason Grebely, head of the Kirby Institute’s Hepatitis C and Drug Use Research Group was awarded $1,498,085 for research to evaluate a national testing program for hepatitis C. “Testing and treatment of hepatitis C is hampered by current health service pathways which require multiple healthcare visits.

People living with hepatitis C are some of Australia’s most marginalised populations, and so it’s vital we reduce the barriers to accessing testing and treatment services,” said Professor Grebely in a statement announcing the grant.

“Our team has previously evaluated a new test for detection of active hepatitis C infection in one hour, called a point-of-care test, which enables same-visit diagnosis

and treatment. This test is now approved in Australia and has changed how testing and treatment can be delivered.”

The Partnership Project will evaluate a national program funded by the Australian government to scale-up point-of-care hepatitis C testing in Australia. The project leverages considerable cash contributions from government ($6.7 million), and from other partners ($670,000 from Gilead and $1.9 million in tests and equipment from Cepheid).

“We are in a unique position in Australia to become one of the first countries in the world to eliminate hepatitis C. This funding will enable us to track and evaluate the program’s implementation, facilitating further scale-up of testing in Australia, and overseas.” v

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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Antihistamines vs Cancer

Can they halve the risk of liver cancer in people with viral hepatitis?

C ommon antihistamines, usually used for the relief of allergies and hayfever, halved the risk of developing hepatocellular carcinoma (HCC or liver cancer) in people living with viral hepatitis during a 10-year follow-up period, according to a study published in Taiwan in January.

The review, published in the Journal of Clinical Oncology, showed people with hepatitis B who used H-1 antihistamines, which are the type used for allergy relief *, on at least 120 days in the follow-up period reduced the risk of liver cancer by a startling 60%.

People with hepatitis B who took fewer antihistamine doses had a smaller reduction in risk, although those with the lowest exposure (2842 daily doses) still had a dramatic 40% reduction in the risk of liver cancer. The study also found similar dose-response relationships were seen in people with hepatitis C and in people with both hepatitis B and C.

by what they see as the unsatisfactory outcomes of treatment for people with advanced liver cancer.

The study used the Taiwan National Health Insurance Research Database to identify people with viral hepatitis, assess their H-1 antihistamine exposure and calculate their risk of HCC. The researchers identified 521,071 people with hepatitis B, 169,159 people with hepatitis C and 39,016 people with both viruses who received health care in Taiwan between 2006 and 2015.

The study excluded people diagnosed with HCC less than a year after a diagnosis of viral hepatitis or with missing data. These people were then divided into those using H-1 antihistamines and those not, and the two groups matched and compared.

The cumulative incidence rate of HCC was significantly

* There are also H-2 antihistamines, which are used to treat gastrointestinal conditions such as acid reflux, indigestion and stomach ulcers.

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

People with viral hepatitis were significantly less likely to develop HCC if they had been prescribed non-steroidal anti-inflammatory drugs (NSAIDS), aspirin or statins.

The researchers say that the relationship between aspirin, NSAIDS and HCC risk needs to be clarified by further research, but they point out that their finding regarding statins and reduced HCC risk confirms separate cohort studies in people with hepatitis B and C. The researchers note that their findings suggest that further research is needed to understand the mechanism by which H1-antihistamines might reduce the risk of HCC, and to clarify whether they could serve as a treatment.

Readers should always seek advice from their doctor regarding liver cancer prevention.

See the original study at bit. ly/3IAkIR3. v

Illustration by Storyset

The researchers in Taiwan were inspired by previous evidence that H-1 antihistamines might have anti-cancer properties, and

lower in H1-antihistamine users in each group after 10 years of follow-up. After adjusting for age, sex and co-morbidities, the risk of HCC was 51% lower in people with hepatitis B who used antihistamines, and 52% lower for people with hepatitis C using antihistamines. The risk was 53% lower in people with both hepatitis B and C who used the antihistamines.

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

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

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

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If you can ring ahead, please do so in case any further changes have taken place.

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March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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Videos for Community Use drinking alcohol responsibly, anyone can see their GP for a liver check and hepatitis test. youtu.be/r-yFqKO6mT4

With the rise of easy access to all manner of information in video format it can be difficult to ‘weed out’ unreliable resources and find those that are really relevant and trustworthy. So – we’ve done that work for you and have collected videos that contain useful, up-to-date and credible information about hepatitis and the liver in general. These brief videos are particularly useful for anyone who may be concerned about their liver health.

The selection below is taken from our library catalogue – for the complete listing go to bit.ly/3sh3Dpw. Hep C cure is easy - a win is a win!

Hepatitis NSW, Sydney, 2021.

Video 2.38 minutes Nat and Suze are about to visit a local shelter and have a conversation about whether starting treatment for hep

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C is “worth the effort”. They discuss their experiences and, for one, their reservations about getting tested and treated, with an end result that they decide that getting rid of hep C is a massive win that anyone should make a priority in their lives. youtu.be/Z8P42iLANeM

Get smart about your liver Hepatitis Queensland, Brisbane, 2021. Video 59 seconds Identifies the five main causes of liver disease and gives information about simple lifestyle behaviours that can reduce the risk of serious liver disease. As well as eating a balanced diet, exercising regularly, and

HEPATITIS SA COMMUNITY NEWS 93 • March 2022

B tested B vaccinated B stronger Hepatitis Queensland, Brisbane, 2021. Video 1:00 minute This powerful animation uses beautiful artwork to show how hep B is transmitted, what effects it has, the importance of getting tested and what preventative or treatment is available. It encourages viewers to have a yarn about getting tested at their nearest clinic. Developed with and for Aboriginal and Torres Strait Islander peoples. youtu.be/DYV2qrQBjvE

Learn more about hepatitis C from Prem, Priya and O’Liver Hepatitis Australia, LiverWELL, Canberra, Melbourne 2020. Video 1:20 minutes Learn more about hepatitis C (and the incidence in Australia and India), some of the risk and transmission factors, how you might know that you have it, and how to organise to get tested and treated. Includes specific information about dental or medical transmission risks in Australia and India. youtu.be/Rp9A3Zd9T7U Living well with hepatitis B Ayanda is pregnant Hepatitis Queensland, Brisbane, 2020. Video 1:52 minutes This animation begins with Ayanda visiting her antenatal clinic where she talks to the nurse about her mother testing positive for hep B. They discuss how hepatitis B may affect her pregnancy and baby—what the specific risks may be and what precautions she can take to protect herself and her baby. youtu.be/rEvjwfMJA-M

Is my liver healthy?

Hepatitis NSW, Sydney, 2020.

Video 1:37 minutes Explains the steps you can take towards a healthier liver.

Outlines what may cause liver disease, what tests are available to test liver health and what they involve, what treatment or preventative measures can be taken for hep B or C, and what other factors will influence liver health. youtu.be/ffFkbx7_R-w Virus protection in your workplace Hepatitis Queensland, Brisbane, 2020. Video 1:22 minutes.

Lists specific careers that could involve a higher risk or exposure to hepatitis. It aims to assist workplaces to be better

informed with information about measures that can be taken to protect staff such as vaccination, PPE, hygiene measure, provision of up-todate training and information. bit.ly/3hcjDDd The role of a GP HealthDirect, Canberra, 2019.

Video 3:23 minutes.

General information about the role of a GP and what they can do for you, some important things to consider when choosing your GP, and what costs might be involved.

Would be of particular interest to those who may be new to the country and unfamiliar with our medical system. bit.ly/3JTJxba

March 2023 • HEPATITIS SA COMMUNITY NEWS 93

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Blood-Safety Education Update your knowledge about blood-safety and viral hepatitis. Sessions include: Overview of hepatitis A, B & C Blood and bodily-fluid safety Best practice after blood exposure Stigma and discrimination Available services

FREE • 1 HOUR BOOKINGS VIA EDUCATION@HEPSA.ASN.AU

FUNDED BY SA HEALTH, BROUGHT TO YOU BY HEPATITIS SA

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HEPATITIS SA COMMUNITY NEWS 93 • March 2022

Useful Services & Contacts Hepatitis SA Free education sessions, printed information, telephone information and support, referrals, clean needle program and library.

(08) 8362 8443 admin@hepatitissa.asn.au www.hepsa.asn.au Hepatitis SA Helpline 1800 437 222 (cost of a local call) Adelaide Dental Hospital A specially funded clinic provides priority dental care for people with hepatitis C with a Health Care Card.

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

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

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

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

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

Lifeline National, 24-hour telephone counselling service.

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

13 14 65

1300 224 636 www.beyondblue.org.au

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

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

(08) 8223 4566

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

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

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

(08) 8406 1600

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

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

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

Viral Hepatitis Community Nurses Viral Hepatitis Nurses work with patients in the community, general practice or hospital setting. They are located in the Adelaide metro area but support can also be arranged for people in country areas. They can be contacted directly by patients or their GPs: CENTRAL: QUEEN ELIZABETH HOSPITAL Jeff: 0423 782 415 Bridgette: 0466 851 759 NORTH Bin: 0401 717 971 Michelle: 0413 285 476 SOUTH Rosalie: 0466 777 876 Lucy: 0466 777 873 OFFICE: (08) 8204 6324 Specialist Treatment Clinics Subsidised treatment for hepatitis B and C are provided by specialists at the major hospitals. You will need a referral from your GP. However, you can call the hospitals and speak to the nurses to get information about treatment and what you need for your referral.

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

Free hepatitis A, B and C information, confidential and non-judgemental support, referrals and printed resources.

We can help. Talk to us.

Call or web chat 9am–5pm, Mon–Fri

Information Support

1800 437 222 2

hepsa.asn.au

HEPATITIS SA COMMUNITY NEWS 93 • March 2022