Page 1

P E H e h T R O T C FA CLEARED

p4 Feature Story

VOLUME 18

THE QUEENSLAND HEPATITIS MAGAZINE MARCH 2017


FROM THE CEO Welcome to the first issue of The Hep Factor for the momentous year that is 2017.

CONTENTS 04 Cleared: with Jo An Interview

08 Treatment Update

For Hepatitis C

12 Hep B Mapping Project

An outline of Hep B in Australia

14 The Doctor is In

Dr Stewart answers your questions

16 New Fact Sheet

Hep C treatment in prison

18 News Roundup

The latest global news

20 Hepatitis Queensland

Activities update

26 News from the North

SHARE YOUR STORY Make a difference in people’s lives and share your story. You don’t have to write like Shakespeare, just be yourself. Contact Elinor on digital@hepqld.asn.au or 07 3846 0020.

CHAT & Cairns Sexual Health news

The HEP FACTOR

Thank you to all those who attended the Hepatitis Queensland (HQ) 21st birthday celebration at the Annual General Meeting (AGM) in November. Your support is very much appreciated.

Editor Jessie Badger/Elinor Thomas

In December, the President of the board and I attended the launch of the much anticipated Queensland Sexual Health Strategy, which includes two plans of great interest to us and to you - the Hepatitis B Action Plan, and the Hepatitis C Action Plan. In preparing these Plans the Department recognised the feedback that strongly indicated the need for separate plans for the hepatitis B virus (HBV) and the hepatitis C virus (HCV). It has since been announced that a new Ministerial Advisory Committee (MAC) on Sexual Health will be formed. MAC membership is yet to be decided and will hopefully include community representation for HBV and/or HCV.

Hepatitis Queensland Board Dr Alison Stewart (President) Mr Kaveen Bachoo (Treasurer) Ms Tanya Bain Dr Paul Clark Ms Pam Muir Dr Andrew Smirnov Dr Lisa Nissen

The major good news from that Strategy launch, is that community based organisations in the sector will be funded for four years, starting July 2017. We do not yet know the deliverables or extent of funding, those details are to be negotiated with Queensland Health in March. A big ‘thank you’ to all our partners in the Hep B Community Education Projects. In 2017 we are continuing the seven projects for which we received funding through Hepatitis Australia. These encompass several migrant/refugee populations in need of HBV information and education support, as well as Indigenous communities. Several projects are anticipating completion by June 2017, while others are in preparatory stages, for implementation throughout 2017/2018. We’re increasing our social media activities at HQ. Keep an eye out for our tweets and posts sharing events, news and resources. I encourage you to get involved in spreading these important messages or initiating your own. Last, but not least, we welcome to HQ a new portable fibroscan machine, affectionately known as Betty. Queensland Health funding has provided Betty and we are busy organising her employment in support of clinicians. The first cab off the rank is West Moreton Prison Health Services with whom we are partnering with Princess Alexandra Hospital, in a treatment program for prisoners. We are happy to discuss deployment of Betty in support of other clinics, with the only catch being that the clinic has to provide the trained operator. We are seeking sponsorship to improve this service. All in all, 2017 is looking very positive. Enjoy The Hep Factor.

Hepatitis Queensland Staff Clint Ferndale - CEO Jessie Badger Harriet Doran Edmunds Lana Richardson Elinor Thomas Stephanie Tugade Jodie Walton Sam White Sandra Wortlehock Hepatitis Queensland Infoline: 1800 HEP ABC (437 222) Office: 07 3846 0020 PO Box 3490 Suite 2, 12 Cordelia Street South Brisbane Qld 4101 info@hepqld.asn.au www.hepqld.asn.au facebook.com/hepqld twitter.com/hepqld The Hep Factor could not be produced without the support of Queensland Health.

CLINT FERNDALE CEO - HEPATITIS QUEENSLAND

2 • The Hep Factor • www.hepqld.asn.au

The Hep Factor • www.hepqld.asn.au • 3


I did have some side effects, but nothing major. Like I said, there’s really no comparison. I had headaches, but for the most part they were manageable with Panadol.”

CURED AND LOVING IT

CLEARED: WITH JO

I was diagnosed. In fact, they didn’t know much about hepatitis C at that stage.

How were those treatments for you?

AN INTERVIEW

Jo has lived with hepatitis for most of her life. She underwent three rounds of the old treatments, none of which

When I got the results I was actually crying. I’ve had hepatitis for 36 years.”

4 • The Hep Factor • www.hepqld.asn.au

cured her of hep C. When the new treatments were released last year, she signed up, but without much hope they would help her. Jo came to HQ to chat with us about her experience of hep C, treatments old and new, and how it feels to be

How long ago is it since you were first diagnosed with hep C? I was diagnosed in either 1992 or 1993, when I was living in Melbourne.

Did you go straight for treatment when you were diagnosed? No, there was a long period of time before I had my first lot of treatment. Quite a number of years, actually.

cured. I don’t think many doctors knew about any sort of treatment when

old

They were pretty much horrific, to put it in one word. I tried the three old ones. The first lot was interferon. I had to have an injection every day for about 6 months, but it was supposed to be 12 because of my genotype.

at the time, especially with this last treatment, supported me financially. It was pretty full on, very hard going.

When did you start the new treatments? How are they in comparison with the old ones? I’m not sure exactly, but it was around August or September 2016.

Next I was on interferon and ribavirin. That’s still daily injections, and up to six tablets a day as well. I think I only lasted on that for 3 months. I was sick as.

There’s really no comparison. Firstly, it was only 12 weeks. I was on Harvoni®, and it was a daily tablet. One tablet as opposed to all the other things you had to have with the other treatments.

Finally, they brought out pegylated interferon, still with ribavirin as well, but the injections became weekly instead of daily. That made it a little better, but I had so many side effects. I couldn’t work. My partner

I did have some side effects, but nothing major. Like I said, there’s really no comparison. I had headaches, but for the most part they were manageable with Panadol. That was pretty good.

At the end of those 12 weeks were you cleared of hep C? Not at the end of the 12 weeks’ treatment. You have to wait 12 weeks post treatment for your final blood tests. That needs to be made really clear to people. You have periodic blood tests, then you wait 12 weeks post treatment and have your final blood test, and wait another few days for the results.

How did that feel? Amazing. I’m a bus driver, and I just happened to be driving a bus when they tried to call with my results. They couldn’t get hold of me so they sent me a text. When I got the results I was actually crying. I’ve had hepatitis for 36 years. I’ve tried all the old treatments and nothing worked. I’ve been through all the troubles one goes through with

The Hep Factor • www.hepqld.asn.au • 5


What advice would you give to someone who’s thinking about treatment?

that sort of stuff. I have supported so many other people, watched them clear on the old treatments.

It was only 12 weeks... and it was a daily tablet. One tablet.”

I didn’t think I would get that result. To be honest with you, I thought “here we go again, it’ll be something else,” even though I’d heard that the percentage cure rates were really, really high. But, I’d had all those other knock backs for so long. It was an incredibly emotional day. It was a passenger who suggested that I pull over and ring my mother to tell her the good news.

Have you changes?

noticed

I really suggest you try it. If you don’t know where to go, there are so many different places now. When treatments first came out, it was only the liver clinics, but now you can go to your GP and pick up prescriptions from pharmacies.

any

I haven’t had a noticeable physical change, but an emotional change. It waxes and wanes because I’ve lived with it for so long. I was relatively healthy, so I didn’t feel it a lot in the latter stages. The old treatments are what I felt most, and earlier I vaguely remember a pain in my liver. I was always worried that I might have been cirrhotic as well, but I wasn’t.

I didn’t think it would work for me, and it did.”

Any final thoughts you’d like to share? Give it a whirl, what have you got to lose? I really don’t recommend that people do detoxing of the liver. Speak to someone that is fairly open minded with the sorts of things you can put into your body. Please, do yourself a favour and give it a go, because I didn’t think it would work for me, and it did.

If you’d like more information about the new treatments, read our latest treatments guide on page 9, or visit our website: www.hepqld.asn.au To find out who can prescribe hep C treatment to you, visit our treatment directory: www.hepqld.asn.au/directory Or call our infoline:

1800 HEP ABC (1800 437 222)

HEPATITIS QUEENSLAND MEMBERSHIP IT’S FREE! If you’re not already a member of Hepatitis Queensland, now is the time to join. There’s never been a better time to help shape the future of the viral hepatitis landscape by having your voice heard. As a member of Hepatitis Queensland you’ll enjoy the following benefits: • Opportunity to help shape government planning and participate in advocacy • Receive the latest industry news with our popular Hep Factor magazine plus our HQ News email newsletter • Be the first to hear about training and events happening in your area • Access our free, comprehensive resources Contact Hepatitis Queensland on 1800 437 222 or info@hepqld.asn.au and ask for a membership form.

6 • The Hep Factor • www.hepqld.asn.au

The Hep Factor • www.hepqld.asn.au • 7


TREATMENT UPDATE: FOR HEPATITIS C

T

he latest Direct Acting Antiviral (DAA) medicines continue the trend of incredible cure rates and greatly reduced side effects seen with the DAAs released last year.

Upcoming Treatments

Teamwork and Interferon Each of these medicines can be prescribed

The Pharmaceutical Benefits Advisory

Tell your doctor / specialist

the following combination of DAA’s be

Before your doctor or specialist can start

added to the Pharmaceutical Benefits

you on treatment they’ll ask you for some

Scheme (PBS) for treatment of hep c

information so they can decide which of

genotype 4.

the above options is best for you.

• •

Hep C genotype

Prior treatment

Liver scarring

Thanks to the DAAs, hep C genotypes 1, 2, 3 and 4 can now be treated without using interferon.

Talk to your medical professional about

Ombitasvir

whether or not you feel ready to start

Combined

with

Ribavirin

if

might impact your ability to take the

PBAC have also recommended the following treatment be added to the PBS for people with genotypes 1 to 6. •

Epclusa®

(sofosbuvir

Combined

medicine as prescribed. Make sure you also let them know: • •

with

Ribavirin

Any other illnesses or health issues you have, and

if

necessary

If you have been treated for hep C before,

+

velpatasvir) •

treatment, and if there is anything that

Any

other

drugs

you

are

Genotypes 5 and 6 still require treatment

Access for All

taking, including prescription

with interferon, but it is combined with

The DAA medicines can be prescribed by

ribavirin and one of the new DAAs to

GP’s and specialists to anyone living with

medication, and any illegal /

make treatment time much shorter than

hep C who is over the age of 18.

before.

8 • The Hep Factor • www.hepqld.asn.au

Paritaprevir with Ritonavir and

necessary

The combination of medicines prescribed will depend on:

populations for treatment.

Committee (PBAC) have recommended

on their own or in combination with others, depending on the situation.

restricted. These groups are priority

medication,

over-the-counter

recreational substances. Telling your medical professional about

People who inject drugs or currently

all the drugs you consume is vital to

reside in prison are not excluded or

prevent negative interactions.

The Hep Factor • www.hepqld.asn.au • 9


Testing after treatment.

Who can write your prescriptions, and where to fill them

The before treatment tests include:

GPs

Tests will be done before, during and

Tests

to

determine

which

can prescribe the new treatments. •

There are two categories of prescriptions

Your body’s response to the

that hep c medicines can fall into, s100

medicine,

and s85.

If the medicine is working to

up at your local pharmacy

Plus Ribavirin

Pharmacies may not stock all the

falls into, and provide you with more

negative effects on your overall

details

Harvoni ® (sofosbuvir + ledipasvir) genotypes 1a/b only 8 - 12 weeks for people with no previous treatment and no cirrhosis

Some prescriptions will only

12 weeks for people who have not been treated before and have cirrhosis, or have been previously treated but do not have

allow you to pick up 4 weeks of

cirrhosis

medicine at a time.

24 weeks for people who have been previously treated and have cirrhosis

Sovaldi ® (sofosbuvir)

tell you which category your treatment

That the medicine isn’t having

12 weeks for people with genotypes 1a/b, who have cirrhosis

your prescription

Your prescribing doctor or specialist will

cure you of hep C, and

24 weeks for people with genotype 3, who have cirrhosis

Daklinza ® & Sovaldi ® (daclatasvir and sofosbuvir)

need to wait 72hours to pick up

experience in treating hep C before they

12 weeks for people with genotypes 1a/b or 3, and don’t have cirrhosis. Can be extended to 24 weeks if treated before

s85 prescriptions can be picked

medicines at all times, you may

they will need to consult a specialist with

blood tests to check:

If your GP has not treated hep C before,

Liver assessment to see if you

s100 prescriptions can only pharmacy

THE LATEST HEP C TREATMENTS FOR GENOTYPES 1 TO 6 Daklinza ® & Sovaldi ® (daclatasvir and sofosbuvir)

be picked up from a hospital

they have experience in treating hep C.

During treatment you will have regular

as

prescribe the new hep C treatments, if

have any scarring (cirrhosis)

such

pharmacy to go to:

infectious disease physicians, can all

genotype of hep C you have •

specialists,

ahead and make sure you know which

gastroenterologists, hepatologists or

Blood tests to confirm that you have hep C

and

When collecting your prescription, plan

12 weeks for people with genotype 2, taken with ribavirin 12 weeks for people with genotypes 5 or 6, taken with peg-interferon

health.

Viekira Pak ® (paritaprevir + ritonavir+ ombitasvir + dasabuvir)

After treatment, you will be tested to see

12 weeks for people with genotype 1b

if the medicines have been successful in curing you of hep C.

Viekira Pak RBV ® (paritaprevir + ritonavir+ ombitasvir + dasabuvir + ribavirin) 12 weeks for people with genotype 1a

INTRODUCING ZEPATIER: FOR TREATING GENOTYPES 1 AND 4

Zepatier ® (elbasvir + grazoprevir + ribavirin)

THE NEW HEP C TREATMENTS

12 weeks for people with genotypes 1 and 4, without previous treatment, with or without cirrhosis.

FOR ADULTS WHO HAVE HEP C GENOTYPES 1-4

2

1& 3

SOFOSBUVIR & LEDIPASVIR

SOFOSBUVIR & RIBAVIRIN

SOFOSBUVIR & DACLATASVIR

(HARVONI®)

(SOVALDI® & IBAVYR®)

(SOVALDI® & DAKLINZA®)

1

95

95

%

%

OF PEOPLE CURED

OF PEOPLE CURED

8, 12 OR 24

12

WEEKS*

WEEKS* MOST PEOPLE HAVE LITTLE TO NO SIDE-EFFECTS.

95% OF PEOPLE CURED

12 OR 24 WEEKS*

GENOTYPE

1

1&4

VIEKIRA PAK®

ZEPATIER

(PARITAPREVIR, RITONAVIR, OMBITASVIR & DASABUVIR)

(GRAZOPREVIR & ELBASVIR)

sometimes with Ribavirin

95% OF PEOPLE CURED

12 OR 24 WEEKS*

95

%

OF PEOPLE CURED

12 OR 16 WEEKS*

* FOR MOST PEOPLE, TREATMENT IS USUALLY TAKEN FOR 12 WEEKS.

TALK TO YOUR DOCTOR, NURSE OR CLINIC ABOUT GETTING READY FOR TREATMENT

Call the Hepatitis Queensland Infoline on 1800 437 222 (1800 HEP ABC) or visit www.hepqld.asn.au

10 • The Hep Factor • www.hepqld.asn.au

Costs

After treatment

The only cost to you is the usual

The new DAA medicines are 90-95%

Pharmaceutical

Benefits

Scheme

co-payment for dispensing the medicine to you.

PEOPLE WITH GENOTYPES 5 - 6 ARE TREATED WITH SOFOSBUVIR TAKEN WITH PEGYLATED INTERFERON AND RIBAVIRIN TREATMENT. THEY HAVE MORE THAN A 90% CHANCE OF CURE.

WANT TO KNOW MORE?

16 weeks combined with ribavirin, for people with genotypes 1a and 4, with or without cirrhosis and with previous treatment.

GENOTYPES

This resource originally developed by Hepatitis NSW, 2016.

GENOTYPES

GENOTYPE

GENOTYPE

12 weeks for people with genotypes 1 and 4, who relapsed on previous treatment, with or without cirrhosis.

This is currently $38.30 for general patients, and $6.20 for concessional

effective at curing hep C. If you happen to be one of the 5-10% who isn’t cured first time, don’t give up. Your GP will refer you to a specialist, who will assess you before starting further treatment.

patients. This co-payment applies each time you collect your prescription from the pharmacy.

For Further Information Talk to your GP, specialist, or clinic nurse. Or call our free Infoline on 1800 HEP ABC (1800 437 222)

To download the full hepatitis C treatment factsheet, visit www.hepqld.asn.au. Hepatitis Queensland would like to acknowledge Hepatitis Australia and Hepatitis NSW for their permission to adapt existing factsheets to provide this information.

The Hep Factor • www.hepqld.asn.au • 11


HEP B MAPPING REPORT BY LANA RICHARDSON

HEPATITIS QUEENSLAND

The latest instalment of the Hepatitis B Mapping Project – Estimates of chronic hepatitis B prevalence, diagnosis, monitoring and treatment by Primary Health Network 201415 was launched in late 2016.

In addition, these levels are not even across Australia, and in some areas there is more of a need for improvement.

Additionally the Hepatitis B Mapping Project Supplementary material to the National Hepatitis B mapping Project Report 2014-15 Estimates of chronic hepatitis B (CHB) prevalence according to Primary Health Network and Statistical Area, 2015 is also available.

Hepatitis B has often been viewed as less significant than hepatitis C, however this document clearly outlines the huge health issues that we are facing in Australia. There are approximately 240,000 people living with chronic hepatitis B in Australia. It is estimated that only 62% of these people are actually aware of their diagnosis, which leaves almost 40% who don’t know they have hepatitis B (approximately 96,000 people).

12 • The Hep Factor • www.hepqld.asn.au

We encourage you to take the time to read this report and consider how hepatitis B affects your local area. You will be able to plot how many people are estimated to be living with chronic hepatitis B, how many are diagnosed, and how many are receiving care and treatment. We urge you to use this information and write to your local member, talk within the local community and raise awareness about hepatitis B in Australia.

For a copy of the report, see link h t t p : / / w w w. a s h m . o r g . a u / HBV/more-about/hepatitis-bmapping-project

If you have any questions about the Hepatitis B Mapping Report or would like to request any specific data, contact Jennifer MacLachlan: jennifer.maclachlan@mh.org.au

“The mapping report allows you to identify which parts of your local area have the highest need for increased access to care and treatment,” said Jennifer MacLachlan, the epidemiologist leading the Hepatitis B Mapping Project.

This is the third update of a very useful document and something that we here at Hepatitis Qld use all the time!

This document aims to facilitate a comprehensive understanding of chronic hepatitis B in Australia.

with hepatitis B compared to the numbers actually receiving treatment. Without significant change in this area, we will see a dramatic increase in the numbers of people living with liver health issues including cirrhosis, liver failure and liver cancer.

The majority of people living with hepatitis B aren’t getting regular checkups to monitor their infection, and only around a third of those who require treatment are accessing it. As you can see in the image opposite, many people who are diagnosed also fall into the category of those who are not being engaged in care or receiving treatment. It is known that 1 in 4 people who have chronic hepatitis B and who aren’t engaged in regular care (six monthly checkups) or treatment will die of liver cancer.

“For example, within Queensland, the highest burden of chronic hepatitis B is within the Southern suburbs of Brisbane, and in the rural Western parts of the state. Treatment access in the Western Queensland Primary Health Network is among the lowest in the country. These areas can be prioritised for increasing awareness and access to services.” This report is also the first time that detailed demographic information about patients accessing treatment, and information about the treatment providers, has been available. For example, this report shows that only 5% of people were treated by GPs and 95% by specialists, which may be limiting access especially to people in rural areas. Particularly as the population living with hepatitis B ages it is important to understand how many people are living

The Hep Factor • www.hepqld.asn.au • 13


THE DOCTOR IS IN DR ALISON STEWART ANSWERS YOUR QUESTIONS ON THE NEW HEP C TREATMENTS

mainly to sus out what genotype of the hepatitis C virus you have

in. The Hepatitis Queensland website also has a directory of

and whether you have suffered significant liver disease as a result

pharmacies keen to be involved in dispensing the new medications.

of having the virus. If you are found to have liver cirrhosis, you will need to have

how to take your medications and send reminders to make sure you

your treatment under the care of a specialist and it is important

pick up your next month’s supply.

that you have ongoing regular check-ups for early detection of

My partner and I both have hep C and we both want to do treatment.

complications. Once these tests have been done, the GP will then discuss which medication and what monitoring you will need while you are on

Dr Stewart is a GP who has been in practice for nearly 30 years. She is curently President of Hepatitis Queensland and Chair of the Board.

treatment. The most important test is 12 weeks after you have completed

H

treatment. This is when we can determine whether you have been

ow do the new hepatitis C treatments differ from the old interferon-based treatments?

Will my regular GP be able to prescribe the new treatments? If so, what’s the typical process?

cured.

One of the key changes that has happened with the new treatments

themselves. In that case, there are a number of options. The

The new Hepatitis C treatments are game-changers

is who can prescribe them.

Hepatitis Queensland website has a directory of GPs who are

for those in the community who have chronic Hepatitis C. They are far more effective, have very few—and mostly mild—side effects and the length of treatment is generally

Previously, only specialists could do so under the “highly specialised drugs” restrictions. People with HCV had to attend a hospital or

half that of the interferon-based treatments. This is really important to know because I think there is still a perception that

from a side effect point of view. A number of the treatments available now simply

have HCV. Research has shown that we may be able to have a big impact on preventing the transmission of the hepatitis C virus by treating groups of people.

As a GP what’s your experience been like treating patients with the new hep C treatments?

a hospital pharmacy.

medications have helped to reduce waiting times and your GP can

the new hepatitis C treatments.

help in that regard by doing as much of the preliminary history-

I was able to tell one of my patients just a couple of weeks ago that

taking and investigations as possible.

they had been cured. She was jumping around the room with joy.

I read that the new treatments for hep C are really expensive, what are the costs involved in accessing treatment?

My reception staff said it sounded like she had won the lottery and

of tea to have to go to a hospital for

Minimal! And you can get your scripts filled in a pharmacy in the

time. She was so excited at getting through the new treatments

appointments. It can be expensive to attend

community.

successfully.

The new treatments have been listed on the Pharmaceutical

So far, all of the patients I have put on treatment have been cured.

a private specialist.

involve taking a tablet a day for 12 weeks—

Don’t leave it just at your partner. Get your friends involved if they

I have had the most rewarding experiences treating patients with

This is fantastic. It is not everyone’s cup

now and for all them it has been a breeze

new treatments are so safe and tolerable.

these are also listed on the Hepatitis Queensland website. The new

Hepatitis C can prescribe the medications.

I have treated a number of patients myself

make an appointment.

celebrate together! There is no reason why you shouldn’t as the

the medications could only be dispensed by

a specialist experienced in the treatment of

to your life, family or relationships.

involved in treatment and you could contact their surgeries to

Do it at the same time and then you will hopefully be able to

Or you can be referred to your local hospital or liver clinic and

treatment of Hepatitis C or have consulted

affect your ability to work or cause disruption

Not all GPs will have the experience or confidence to treat you

Can we do it at the same time or should we do it one person at a time?

specialist clinic of one sort or another and

Now GPs who are either experienced in the

treatment is difficult or onerous and might

Pharmacies will also often provide good reinforcing advice about

she told them that she had! She had previously tried interferon treatment and had a terrible

no injections required. And the cure rate is

Being able to go to your GP to get treatment

Benefits Scheme and as long as they are prescribed according to

It is a monkey off their backs. It is a relief for them and I think can

pretty close to 100%.

is a major bonus for those worried about

the guidelines and you have a Medicare card, the cost to patients is

change their attitudes with respect to managing their health into

stigma or discrimination. At the GP surgery,

exactly the same as the cost of any other prescription.

the future.

For people with a health care card, this will be around $6 for a

Obviously, it can feel a little weird for some patients to no longer

month’s supply. For those without, it will be around $35. In certain

have a disease that they may have had for 20, 30 or 40 years and

cases, treatment involves two separate medications and then the

that can take some adjusting.

cost will be additive.

As their GP, you can help them out in this regard as well. And

Of course, the cost of the medications to the government is much

Hepatitis Queensland staff are only a phone call away if you feel

greater and this is what has received some publicity.

that the patient might need some ongoing support.

One of the reasons I get so excited about

you are just another patient sitting in the

the new treatments is the second chance it provides to those who had interferonbased treatment in the past which was

Dr Alison Stewart speaking at 2016 Annual General Meeting

unsuccessful or had to be ceased because

due mental health concerns or other health or lifestyle issues. Now, everybody with chronic HCV should be considered for the new treatments and the vast majority will be right to go regardless of what stage their liver disease is and the other medical conditions they might have.

relationship with a GP who is aware of our history and circumstances. You don’t have to start from scratch.

of side-effects. There were many people who could not have treatments previously

waiting room! And many of us have a close

If you think you may have been at risk of contracting Hepatitis C, now is the time to go and see your GP and ask to be screened. Or if you have been holding off from seeking treatment because of worries about side effects, make an appointment to get the ball rolling. Your GP will need to ask you some important questions regarding your medical history, what medications you are on, and whether you have had treatment previously. You may need to start contraception to prevent pregnancy while on treatment. You will also need to have some initial tests performed. These are

14 • The Hep Factor • www.hepqld.asn.au

But the federal government has decided to subsidise the cost of the new treatments to the community because of the significant benefits that will flow—especially reducing the rates of cirrhosis,

For more information on the new hepatitis

liver failure and liver cancer but also improving the general quality

C

of life of those affected. People in Correctional Centres will also be able to access the medications through the highly specialised drug program. There are costs involved in pharmacies stocking the medications on

treatments

please

visit

the

Hepatitis

Queensland website at www.hepqld.asn.au or call our infoline on 1800 HEP ABC (1800 437 222).

their shelves. Your pharmacist may have to order the medications

The Hep Factor • www.hepqld.asn.au • 15


Have you thought about getting hep C treatment in prison? Created February 2017; Review August 2017

Have you thought about getting hep C treatment in prison?

Hepatitis Queensland

First, how do I check if I have hep C? There are two blood tests to check for hep C.

1. Antibody test - shows if you have or have ever had hep C in the past (25% of people clear hep C naturally, but everyone will still have antibodies). If you get a positive antibody test, you need to have a PCR test. 2. PCR test (hep C virus test) – shows if the virus is still in your blood, and if you still have hep C.

Can people in prison get hep C treatment?

Created February 2017; Review August 2017

How do I get treatment in prison? 

 

Put in a form to medical asking for hepatitis C treatment. Be patient, there are waiting lists. If you have advanced liver disease or cirrhosis you may need to visit the hospital liver clinic, but you can still get the new treatments.

What is the treatment? How long does it take?

Will it cost anything to go on the treatment?

In most prisons there is no cost, the government pays for treatment both in the prison and in the community. If you start your treatment in the community, you will only need to pay for the dispensing fee ($6.30 if you have a health care card or $38.80 if you are working). The actual medications are free. In some private prisons you will have to pay the $38.80 dispensing fee.

What is the chance of me getting a cure from these new medications?

The new medications have a 95% cure rate – you won’t have hep C anymore!

Are there any bad side effects? Will it affect my mental health?

No, the new medications are very different to the old interferon based treatment. Most people will have either no side effects or very minor side effects – like a headache or tiredness. The new medications do not have mental health side effects, people can still work full-time and continue normal activities while on treatment.

For more information contact Hepatitis Queensland

www.hepqld.asn.au or call the infoline 1800 437 222

1 of 2

Several options for treatment in the community many of which are drug user and prisoner friendly services. These include; 

 Illustrations by Julie Haysom 2017

Illustrations by Julie Haysom 2017

If you are due for release you may have to wait to start treatment until you are in the community. You can call Hepatitis Queensland on the Arunta system (number 12) to get contacts of people treating for hepatitis C in your area.

What if I’m on a short sentence and want to do treatment in the community?

 

Treatment times will vary. People will have 1-2 tablets a day for 8-24 weeks. However, for most people treatment will only be 12 weeks long.

Yes! People in prison can get treatment. Most centres like to start and finish the treatment while you are inside. So, if you are on remand or haven’t been sentenced yet they might wait to start treatment.

Illustrations by Julie Haysom 2017

Hepatitis Queensland

What if I am using drugs?

In the community, people who use drugs are a priority group for hep C treatment. In prison, you may need to consider your own ability to control getting hep C again, especially without access to bleach. You may be able to stop getting hep C again. In time, better health options may be in place to prevent the transmission of hepatitis in prison. However, choosing not to do treatment may impact your liver health. So consider your options and what is right for you.

 

QuIHN (Qld Injectors Health Network) is treating people who use drugs, or have a history of using drugs in Brisbane; Gold Coast; Sunshine Coast and Townsville. Contact QuIHN on 3620 8111 Sexual Health Clinics and Community Health AODS, methadone clinics and some rehabilitation centres Aboriginal Health Clinics including ATSICHS, which is treating out of Woolloongabba, Logan, Acacia Ridge, Browns Plains & Northgate. Contact the Woolloongabba office on 3240 8924 GP’s can also now treat for hep C Liver clinics are still providing treatment for hep C, especially people with cirrhosis.

Support and Information

If you have a question call Hepatitis Queensland on the free prisoner Arunta system number 12. You can also request a FREE info pack when you call. Or FREE call in the community 1800 437 222 (1800 HEP ABC)

Some people are deciding to do treatment with people they use with, to reduce the risk of reinfection. Many people are also doing treatment in prison at the same time as their partners and friends in the community. Researchers say that by working together in this way communities will become completely hep C free within 10 years.

For more information contact Hepatitis Queensland

www.hepqld.asn.au or call the infoline 1800 437 222

2 of 2


2.

2 SPiRiTS Program funding stops The Queensland AIDS Council (QuAC) will lose funding for their 2 Spirits program on 30 June 2017.

This program has run for over 20 years, providing education and support to Aboriginal and Torres Strait Islander gay men, sistergirls, people with HIV, and their families to develop appropriate ways of addressing sexual health issues. The 2 SPiRiTS Program produced the iconic Condoman, a superhero who promoted condom use. Condoman is one of the most recognisable health promotion campaigns in Australia. QuAC director, Michael Scott, is concerned about what the loss of funding will mean for Indigenous LGBTI people. Losing this program could affect the distribution of HIV preventative medicines, making it harder to access for the people who need it. 2 SPiRiTS is not the only Indigenous sexual health program to

NEWS ROUNDUP

lose funding this year, the Northern Territory AIDS and Hepatitis Council’s (NTAHC) Aboriginal Sexual Health Program will also lose federal funding from 30 June 2017. QuAC and NTAHC have started a petition on Change.org aimed at reversing the funding cuts to these two programs, and keep them running after 30 June 2017. Support for the campaign on social media can be voiced using the hashtag: #LGBTIBlackLivesMatter

We’ve got the latest news from around the globe on all things hepatitis

1.

Prisons at the frontline in the

borne viruses, such as Hepatitis and HIV, among the prisoners, the

battle against deadly viruses

prison staff, and the wider community.

The Australian Medical Association (AMA) has voiced their support for Needle and

Prisons currently act as reservoirs for blood borne viruses.

3.

Australasian Viral Hepatitis Elimination Conference 2017 There is an urgent need to increase the number of clinicians able to treat hepatitis B and hepatitis C. Until 1.3.16, therapy

Abstract submission opened late February and Registration opens early March. For more information please view www.avhec.com.au

4.

GESA

updated

treatment

hepatitis

guidelines

C for

medical practitioners The

Gastroenterological

Society

of

Australia, in collaboration with their partners, have released their recommendations for the management of hepatitis C virus

uptake for HCV was slow, due to both hard to reach priority

infection.

populations and the difficulty and length of the treatment itself.

These recommendations include updates on who can prescribe

In hepatitis B, many people remain undiagnosed and confusion still exists around the idea of a ‘healthy carrier’, masking the need

hep C medicines, recent additions to the Pharmaceutical Benefits Scheme and updated recommendations on monitoring people

When an untreated prisoner returns to the community, they risk

for monitoring and, in some cases, the prescription of effective

spreading infection to the people they come into contact with.

therapy.

Needle and syringe programs can go a long way to preventing

This is the first time that the Australasian Viral Hepatitis

practitioners, patients and the general public on hepatitis C, visit

should have access to sterile needles and syringes, bleach, and

transmission within prisons, which will reduce the risk of

Elimination Conference will be held. It is to be held in the off-

their website:

condoms.

transmission in the community as well.

Syringe Programs for prisoners. Dr Michael Gannon, president of the AMA, stated that all prisoners

Access to these items would slow and prevent the spread of blood

18 • The Hep Factor • www.hepqld.asn.au

year of the Australasian Viral Hepatitis Conference to cater for the educational needs of clinicians and researchers given the major changes that are happening in the sector.

during treatment. To read the full report, or download their resources for medical

https://www.gesa.org.au/index.cfm//resources/hepatitis-ctreatment/

The Hep Factor • www.hepqld.asn.au • 19


5.

 World

Hepatitis Summit 2017,

Brazil 1-3 November The second World Hepatitis Summit will be held in Sao Paulo, Brazil, from 1 to 3 November 2017.

The theme of this year’s summit is: Implementing the Global Health Sector Strategy (GHSS) on Viral Hepatitis: Towards the Elimination of Hepatitis as a Public Threat The summit is a large-scale global event hosted by the World

medical professionals use. The AIVL booklet, Hep C and You: A Users Guide to the Latest Information, also covers testing, treatment and symptoms, but they talk more about genotypes, other illnesses associated with hep C infection, and liver monitoring. It’s your body, so make sure you understand what the doctors and nurses are telling you about hepatitis, with help from this great resource. The Hepatitis Australia handbook can be found here:

Health Organisation (WHO) and World Hepatitis Alliance (WHA)

http: //www.hepatitisaustralia.com/s/hep_c_handbook_

every two years.

interactive_20160726.pdf

The WHO and WHA set up the first summit in 2015, to strengthen

The AIVL handbook can be found here:

the voice of people affected by hepatitis on an international scale.

http://www.aivl.org.au/wp-content/uploads/HEPC-and-YOU.pdf

The three-day event will bring together civil society groups, the WHO and its Member States, patient organisations from the World Hepatitis Alliance’s 246 organisational members, policy-makers, public health scientists and funders. Hepatitis is the world’s second biggest killer. Worldwide, ten million people have viral hepatitis. 95% of those people are unaware of their infection, and only 1% access treatment. 1.4 million people die from viral hepatitis every year.

7.

Burnet

Institute

Received

$7 million Grant to Eliminate Hep C More than 230,000 Australians live with

chronic hep C infection, worldwide that number escalates to 10 million people. The elimination of Hepatitis C virus as a global public health

The goal of the WHO and WHA is to save 7.1 million lives by 2030

threat is the goal of the Burnet Institute’s Professor Margaret

with awareness, vaccination and treatment.

Hellard, Head of their Centre for Public Health.

(For more information, watch the WHA’s video here: https://youtu.

The National Health and Medical Research Council (NHMRC)

be/cVttqfgExL0)

awarded Professor Hellard and her team $7 million so they could

6.

 New

Hep

C

Handbooks

Available Hepatitis Australia and the Australian Injecting and Illicit Drug Users League

(AIVL) have released great Hepatitis C handbooks. The aim of these handbooks are to deepen the understanding of people affected by hep C: that’s individuals who are infected, their families, or anyone else who wants to learn more about hepatitis. Using these resources, everyone can make well-informed decisions about their health and wellbeing. It’s all about making the right choices for you. The Hepatitis Australia booklet, The Hepatitis C Handbook: No

take part in the global response to hep C, and eliminate it by 2030. Professor Hellard’s focus will be on research into how to stop the spread of hep C, and how to make sure that it does not go untreated. “We need prevention, and we need to ensure people are diagnosed, treated and cured,” she said. Professor Hellard’s research will also continue in the development of the highly effective direct acting anti-viral (DAA) medications, a great leap forward in curing hep C quickly and with few side effects.

The World Hepatitis Summit is a joint initiative between the WHO and the World Hepatitis Alliance, and is hosted, co-sponsored and organised in collaboration with the Brazilian Government.

We have the commitment of 194 countries to achieve elimination of viral hepatitis as a public health threat by 2030. Let us all come together at the Summit and step up the response to turn the elimination goal into a reality.”

The theme of the World Hepatitis Summit 2017 is Implementing the Global Health Sector Strategy on viral hepatitis (GHSS): towards the elimination of hepatitis as a public health threat. The event will bring together Ministers of Health, policymakers, representatives from international implementers and donor agencies, health professionals, patient organizations and civil society.

Dr Gottfried Hirnschall, Director of the HIV/AIDS Department and the Global Hepatitis Programme of WHO

Nonsense, Straight Up Facts, covers everything you need to know: the definition of hepatitis and comparing three main viral strains (A, B and C); testing, treatment and symptoms; telling work colleagues, managers and insurance companies; myth busting; transmission; and, provides a glossary of all the terms that

20 • The Hep Factor • www.hepqld.asn.au

www.worldhepatitissummit.org

The Hep Factor • www.hepqld.asn.au • 21


HEPATITIS QUEENSLAND ACTIVITIES UPDATE PRISONER EDUCATION

CORRECTIONS AND NON-CLINICAL WORKFORCE DEVELOPMENT PROJECT

Free Prison Phone line

There should be more education for people to access upon coming to jail”

In 2016, over 7000 pocket cards promoting the free call prison line to Hepatitis Qld were distributed to correctional centres state-wide.

Peer mentor Program

We continue to receive regular calls from people in custody through this service, especially in relation to access to new hepatitis C treatments. If you know someone in custody, let them know they can contact us on the free Arunta prison line number 12.

In 2016, Hepatitis Queensland ran three Peer Mentor programs. The course covered several topics including; liver health; new treatments; safer injecting; overdose prevention; drug triggers; living well; discrimination and stigma and self-care, diet and exercise in a prison environment.

Prison Resources A number of prison specific resources are in development and will be distributed early 2017. •

A new fact sheet for correctional centres is the first resource to be made available, that explains the process of hep C testing and treatment when in custody. See pages 16-17. A basic English comic poster will accompany the fact sheet for display in education and medical centres in prisons across Qld. new deck of playing cards with prisoner art and links A to health service will also be distributed in the first quarter of 2017.

With new hep C treatments rolling out around the country we look forward to supporting people in custody in moving forward to accessing appropriate testing, treatment or links to hep C treatment services in the community upon release.

Two courses were delivered in Brisbane Women’s Correctional Centre and one in a men’s prison (Capricornia) in Rockhampton. All participants increased their knowledge or confidence as a peer educator, or increased both. The programs were very popular, with reserve lists at both centres. We really enjoyed delivering the courses, and some great peer education started taking place at both centres.

22 • The Hep Factor • www.hepqld.asn.au

In 2016, fourteen sessions were delivered at the Academy to 270 correctional officers in Brisbane, Townsville and Rockhampton.

feel confident in educating and informing patients”

stick injury’s, sharps disposal, blood spills, disclosure and discrimination, and safe work practices.

Workshops for non-clinical staff in Alcohol and

Hepatitis B and C training workshops for Nurses

Drug Facilities and Rehabilitation facilitie s

in the West Moreton Correctional Services

In 2016, seven sessions were delivered to 120 participants,

Two sessions were delivered to 14 nurses working in the West

in Inala, Ipswich, Toowoomba, Southport, Brisbane and Rockhampton.

Moreton Prison Health Services. Thanks to Penny Wright, CNC, PA Hospital and Melinda Hassall, CN, ASHM for assisting in the delivery of this education.

Fibroscan Familiarisation Training with West Moreton Prison Health Services . Nurse Practitioners from Brisbane Women’s Correctional Centre, Borallon Correctional Centre, Arthur Gorrie Correctional Centre and Wolston Correctional Centre attended a half-day Fibroscan familiarisation training day. The proposed timing of the Fibroscan being deployed to the Prison Health Services will

This estimates to an average of 6000 conversations per year occurring in a hard to reach population due to peer education. 1500 resources were distributed to peer educators during the course sessions, with a further 600 being collected by peer educators to provide to other prisoners.

Get your FREE information pack mailed to you today.

Very interesting session. Learnt a lot and

These were 2 hour sessions covering hepatitis A, B & C, needle

Tally sheets demonstrated on average that prisoners did 4 brief interventions per week with other prisoners after the peer education course.

Call Hepatitis Queensland on Arunta prison number 12 • how you get hep C or B • how you can look after yourself • about new treatments that cure hep C.

Entry Officer Program

Peer mentors conducted post course evaluation, and recorded the number of prisoners they spoke to as part of the mentor program.

Are you in custody or know someone who is? Get the latest hepatitis information

Staff in QLD Correctional Centres- Custodial

be in early April 2017. Hepatitis Queensland is currently working with other service organisations to provide outreach Fibroscan clinics in South East Queensland.

UPCOMING WORKSHOPS Workshops dates: Non-clinical staff in Alcohol and Drug Facilities and Rehabilitation facilities • •

Phone 07 3846 0020 for more information.

9th May, Caboolture 29th May, Inala

Free call Monday to Friday 9.00am to 5.00pm.

Free call: Arunta number 12 or 1800 437 222 (1800 HEP ABC)

The Hep Factor • www.hepqld.asn.au • 23


HEPATITIS QUEENSLAND ACTIVITIES UPDATE

HEPATITIS B COMMUNITY EDUCATION PROJECTS The first six months of the hepatitis B community education projects has been busy! As we speak we are nearing completion of our project working with TAFE Queensland. This project has developed a set of hepatitis B resources in basic English for students from culturally and linguistically diverse backgrounds studying English language courses at TAFE locations across Queensland.

Do you want to take part in the Africa films project? Contact us using the information below

Initial discussions with the Ethnic Communities Council of Queensland and TAFE educators identified low levels of knowledge about hepatitis B, and a need for information to be articulated in easy to understand language for students learning English. A reader, workbook and teacher’s resource will be finalised in the coming weeks and printed and ready for distribution in March 2017. The African films project is well underway, with the wonderful team at Chick Flicks engaged to develop and produce a short film that raises awareness of hepatitis B for the African community in South-East Queensland. Focus group discussions have taken place with members of the Eritrean, Liberian, Nigerian, Rwandan, Somalian, South Sudanese, Tanzanian, Togolese and Zimbabwean communities in Brisbane to gain support for the project and exchange ideas on potential film concepts.

If you are interesting in working with us, or want more information about the projects please contact Harriet at hepbprojects@hepqld.asn.au or Lana on abc@hepqld.asn.au or phone 07 3846 0020.

24 • The Hep Factor • www.hepqld.asn.au

The script is currently being finalised and focus tested and filming is expected to commence in March. Project completion is anticipated for May 2017. Stay tuned for updates on the launch of this exciting initiative!

November 2016 saw The B team heading up to Cairns and Thursday Island to begin consultation with our friends and stakeholders in Northern Queensland for the two hepatitis B community education projects for Aboriginal and Torres Strait Islander communities in Cairns, Bamaga and the Torres Strait Islands. We were warmly welcomed and well looked after by Rhondda Lewis, Carla Gorton and the fabulous team at Cairns Sexual Health. In Cairns, stakeholder consultations took place with individuals from Cairns Sexual Health, Queensland Health’s Tropical Public Health Unit, 2Spirits, The Aboriginal and Torres Strait Islander Health Alliance, Cairns Hospital Outreach Clinic, Alcohol Tabaco and Other Drugs Services, Wuchopperen Health Service and Queensland Positive People. Consultations on Thursday Island consisted of the team at Thursday Island Men’s and Women’s Health Unit, the Thursday Island Primary Health Care Unit and Queensland Health staff based at the Torres and Cape Hospital Health Service. Stakeholder consultation will continue to take place in the up-coming months to finalise activities with the projects officially commencing in June 2017. All other projects are ticking away nicely. Consultations regarding project activities have taken place with organisations that work and represent the Chinese, Vietnamese and African communities in Brisbane, as well as the Ethnic Communities Council of Queensland, MDA and the Mater Hospital Refugee Services. Stay tuned for further updates from the B team in the next exciting edition of the Hep Factor out in August 2017. If you would like further information about the projects please contact the Hep B Team - Harriet Doran Edmunds and Lana Richardson, on 07 3846 0020.

DIGITAL TRANSFORMATIONS New website Work on our new responsive website is in full swing with completion expected very shortly. The new website will feature more user-friendly navigation, clearer campaign notices and easier to find resources. The site will also be more accessible across multiple devices such as smartphones and tablets. We are also excited about the new look treatment directory that will feature in the new website. Stay tuned for updates! Hepatitis Queensland Email News Our email subscriber base continues to grow and grow for our revamped monthly email newsletter. Each month we deliver the latest hepatitis news, events and research to our subscribers. A recent survey has provided positive feedback on the new look and feel. If you haven’t yet subscribed please visit the News/Subscribe section of our website: www. hepqld.asn.au. Social media Another avenue for communicating with Hepatitis Queensland is through our social media channels. You can get in touch with us and follow our news and messages through Facebook and Twitter. Facebook.com/hepqld Twitter.com/hepqld

SUBSCRIBE TO OUR NEWSLETTER VISIT WWW.HEPQLD.ASN.AU > NEWS > SUBSCRIBE

The Hep Factor • www.hepqld.asn.au • 25


Dr Glen Curran, Clinical Nurse Consultant

NEWS

from the

Cairns Sexual Health Service The hepatitis B project team will be working with Aboriginal and Torres Strait Islander communities in Far North Queensland to improve hepatitis B services. Dr Glen Curran (Clinical Nurse Consultant), Robyn Wilson (Hep B Data Manager), and Yvonne Drazic (Project Officer) will help to review the historical information informing hepatitis B literature as it relates to Aboriginal and Torres Strait Island people and services living in Far North Queensland. The project aims include improving: communication links between stakeholders; the way we manage data; recall systems; access to fibroscanning; and staff knowledge levels around hep B.

26 • The Hep Factor • www.hepqld.asn.au

NORTH Cairns Hepatitis Action Team Stay up to date with the latest news and events from the CHAT team. Visit their facebook page: facebook.com/CairnsHepActionTeam


SOFOSBUVIR & LEDIPASVIR

12

8, 12 OR 24

MOST PEOPLE HAVE LITTLE TO NO SIDE-EFFECTS.

WEEKS*

WEEKS*

12 OR 24

* FOR MOST PEOPLE, TREATMENT IS USUALLY TAKEN FOR 12 WEEKS.

WEEKS*

12 OR 24

OF PEOPLE CURED

95%

(PARITAPREVIR, RITONAVIR, OMBITASVIR & DASABUVIR)

WEEKS*

12 OR 16

OF PEOPLE CURED

95%

(GRAZOPREVIR & ELBASVIR)

ZEPATIER

1&4

GENOTYPES

Call the Hepatitis Queensland Infoline on 1800 437 222 (1800 HEP ABC) or visit www.hepqld.asn.au

WANT TO KNOW MORE?

TALK TO YOUR DOCTOR, NURSE OR CLINIC ABOUT GETTING READY FOR TREATMENT

PEOPLE WITH GENOTYPES 5 - 6 ARE TREATED WITH SOFOSBUVIR TAKEN WITH PEGYLATED INTERFERON AND RIBAVIRIN TREATMENT. THEY HAVE MORE THAN A 90% CHANCE OF CURE.

WEEKS*

OF PEOPLE CURED

OF PEOPLE CURED

95%

95%

95%

OF PEOPLE CURED

(SOVALDI® & DAKLINZA®)

(SOVALDI® & IBAVYR®)

(HARVONI®)

sometimes with Ribavirin

VIEKIRA PAK®

SOFOSBUVIR & DACLATASVIR

1

SOFOSBUVIR & RIBAVIRIN

GENOTYPE

1

GENOTYPES

1& 3

2

GENOTYPE

GENOTYPE

FOR ADULTS WHO HAVE HEP C GENOTYPES 1-4

THE NEW HEP C TREATMENTS

This resource originally developed by Hepatitis NSW, 2016.

Profile for hepqld

The Hep Factor Summer 2017  

The Hep Factor Summer 2017  

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