National Hepatitis C Action Plan Oversight Group Terms of Reference –
DRAFT Updated June 2023
1. Purpose
A National Hepatitis C Action Plan for Aotearoa New Zealand 2020 – 2030 (the action plan) has been developed by the Ministry of Health (the Ministry) in collaboration with an external working group. New Zealand is one of 194 countries that adopted the WHO strategy to eliminate viral hepatitis as a public health threat by 2030. The plan, published in July 2021, is New Zealand’s response to the WHO’s call to action and our first step in developing an overall viral hepatitis strategy.
The purpose of the National Hepatitis C Action Plan Oversight Group (the Oversight Group) is to guide and monitor implementation of the action plan This includes monitoring performance measures to track progress and assess the impact of activities to identify successes and areas for improvement as we work towards our elimination goal.
2. Te Tiriti o Waitangi
The Oversight Group will recognise Te Tiriti o Waitangi obligations and consider how greater equity for Māori will be achieved. This includes a commitment to rangatiratanga (authority, ownership, leadership) and mana motuhake (self-determination, autonomy) and the provision of protection of Mātauranga Māori.
The Oversight Group will promote Māori participation and representation at all levels of implementation of the action plan, and this will be reflected in its membership.
Māori are a priority group in the action plan as emerging data suggests that Māori have a higher prevalence of hepatitis C than other population groups and may be at higher risk of hepatitis C and the long-term complications of chronic infection. The action plan prioritises Māori on the basis of increased need and our Te Tiriti o Waitangi obligations to actively improve health outcomes for Māori and reflect Māori health aspirations. The action plan includes initiatives to improve awareness, testing and treatment of hepatitis C, and improve access to services for Māori.
3. Achieving equity
It is a priority for the government to deliver equitable health outcomes for all New Zealanders. In Aotearoa New Zealand, people have differences in health that are not only avoidable, but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.
To be successful the system must deliver the same high-quality outcomes and wellness for all people to reach their full potential no matter where they live, what they have or who they are.
The action plan takes a national public health approach to achieve health equity and improve wellbeing for all people living with hepatitis C. One of the expected long term outcomes is improved health equity for Māori through a reduction in the incidence and mortality from hepatitis C. This includes equitable outcomes in terms of diagnosis and treatment, and improved outcomes
for Māori across all the areas of prevention, awareness, testing and screening, as well as increased integration of services and access to care.
Activities in the action plan were assessed on how well they promote improvements to health equity and Māori health aspirations. Priority was given to activities that aim to increase equity and improve the overall wellbeing of New Zealanders and their families. Ground breaking hepatitis C treatments improve the chances of people with hepatitis C being cured. Increasing access to appropriate care for those most at risk is a key way of improving equity.
The Oversight Group will be guided by the Ministry’s working definition of equity to guide and consider the influence of the system on equity. The Oversight Group also acknowledges the Aotearoa Statement on Closing the Gap on STIs, & BBVs Among Indigenous Peoples of Australasia 1
4. Background
Hepatitis C is a blood-borne virus that causes inflammation of the liver It is a significant public health issue in New Zealand. The rising burden of disease includes increasing illness and deaths from cirrhosis and liver cancer due to chronic hepatitis C.
New Zealand has a unique opportunity to eliminate hepatitis C in the next 10 years, as a publicly funded, highly effective direct-acting antiviral treatment is now available. Maviret can cure 98 percent of people with chronic hepatitis C regardless of the type of hepatitis C virus they have. The real prospect of curing hepatitis C will make a huge difference for the approximately 30,000 New Zealanders estimated to be living with chronic hepatitis C2 .
Approximately 35 to 40 percent of New Zealanders with chronic hepatitis C are undiagnosed because of a lack of awareness of previous exposure and lack of any specific symptoms associated with hepatitis C infection. Without treatment, most will develop progressive liver damage and almost one quarter will progress to cirrhosis. Hepatitis C cirrhosis is the leading cause of liver transplantation in New Zealand and the second leading cause of liver cancer (behind hepatitis B). Early treatment with direct-acting antiviral treatment prevents these complications and can be accessed in primary health care and other community settings, making treatment uptake easier for all New Zealanders living with hepatitis C.
The action plan has been developed to guide the health sector and services working in hepatitis prevention or treatment. It provides a framework for working towards the WHO’s goal to eliminate viral hepatitis by 2030. It focuses limited resources on the priorities that will have the greatest impact on reducing inequities, improving Māori heath and improving outcomes for all New Zealanders living with hepatitis C.
The action plan has five main priority focus areas and goals that contribute to the overarching elimination goal
• Awareness and understanding
• Prevention and harm reduction
• Testing and screening
1 https://nzshs.org/events/the-aotearoa-statement
2 Approximately 15,000 people with hepatitis C have been treated in the past 9 years and it is estimated that there are approximately 30,000 New Zealanders still living with hepatitis C. Following the outcome of modelling on hepatitis C, updated population estimates are expected to be confirmed in 2023
• Surveillance and monitoring
• Integration of services and access to care.
Key outcomes, objectives and activities are grouped under each of these focus areas. The plan also defines priority groups, priority settings and the target audience. Guiding principles3 support the overarching development and implementation of the action plan. These principles reflect our Tiriti obligations, and will help us ensure that our work is informed by the experiences of people living with or cured of hepatitis C, and of our priority populations
Implementation of the Hepatitis C Actions Plan is a priority action in Te Pae Tata – the Interim Health Plan for Aotearoa New Zealand
A phase one implementation plan has been developed to guide the initial work to be delivered from 2021-2025. The priorities for 2023/24 are summarised below.
Implementation priorities for 2023/24
• Continue to increase access to testing and treatment through more nurse led clinics and peer-led point-of-care testing to be delivered in the community and mobile clinics
• Continue to support the Needle Exchange Programme to upscale the distribution of free injecting equipment to people who inject drugs to focus on prevention and reducing new infections
• Launch the National Hepatitis C HealthPathway and promote to GPs, and Māori health providers
• Hepatitis C surveillance system / registry options agreed and next steps confirmed.
• Modelling to be completed, hepatitis C population estimates updated
• Promote a wide range of World Hepatitis Day activities and events to raise awareness about hepatitis C testing and treatment.
• Continue work to widen prescribing to include nurses and pharmacists following the recommendations from the Medicines Classification Committee
• Work with Corrections to progress a range of STBBI actions with an initial focus on the Hepatitis C Action Plan actions that aim to improve access to and uptake of hepatitis C testing and treatment services in prisons.
• Investigate the appropriateness and design of a feasibility study of universal testing of the general population in a single geographical area of New Zealand.
• Further refine the cost-effectiveness model of universal versus targeted testing for increased diagnosis of hepatitis C in New Zealand.
• Promote nationally consistent strategies to combine hepatitis C and B testing for Māori and Pacific peoples.
Sexually Transmitted and Blood Borne Infections Programme
A cross-agency Sexually Transmitted and Blood Borne Infections (STBBI) programme was established in February 2023 to support the vision of an Aotearoa New Zealand where STBBI are prevented and where all people living with STBBI live long and healthy lives free from stigma and discrimination.
3 See section 1 in the National Hepatitis C Action Plan for Aotearoa New Zealand 2020 – 2030
This programme brings together implementation of the Hepatitis C, HIV and Syphilis Action Plans, management of the Needle Exchange Programme and other related work programmes including Hepatitis B and other non-governmental and community organisations.
This work also aligns with the National STBBI Strategy 2023- 2030 published in March 2023 which aims to improve collaboration, support collective action and set a unified strategic direction for the health agencies and the health and disability sector.
The Commissioning team in Te Whatu Ora is leading the implementation and coordination of the STBBI programme in partnership with Te Aka Whai Ora and the Public Health Agency in Manatū Hauora.
5. Scope of responsibility
The Oversight Group is responsible for:
• supporting and promoting phase one of the implementation of the action plan monitoring performance measures to track progress, assess the impact of activities to identify successes and areas for improvement
• contributing advice and guidance to support implementation of key activities including reviewing the quality of what is being delivered
• supporting the review of lessons learned and continuous improvement developing an annual work plan to guide oversight and quarterly review of progress
• identifying priorities for phase two of the implementation plan
6. Roles and responsibilities of members
The Chair (or Co-Chair) is responsible for:
• providing leadership to the Oversight Group and running efficient and effective meetings that result in clear resolutions and actions
• acting as spokesperson for the Oversight Group and any working groups
• corresponding and working with the other national networks as required
• reviewing and approving meeting agendas, minutes, invitations to external individuals, and official correspondence from the Oversight Group before distribution
• assisting with conflict resolution within the Oversight Group and with members of other organisations should such arise.
Te Whatu Ora is responsible for:
• day to day management of delivery of phase one implementation of the action plan and wider hepatitis C work programme
• funding, procurement and contractual decisions
• risk management
• sector communications and media spokesperson roles
• coordination and secretariat support, including:
o supporting the Chair and the Oversight Group to maintain progress
o scheduling meetings, preparing agendas and supporting papers and distributing these in advance of the meetings, following up with meeting minutes and action points.
Oversight Group members are expected to:
• keep their respective organisations and networks updated on the work and be able to provide feedback to the Oversight Group on behalf of the communities they represent
• contribute to the efforts of the Oversight Group through timely and effective communication and regular attendance at meetings.
7. Length of term
Membership is required from July 2023 until June 2024 and will be reviewed annually, while ensuring that continuity of knowledge is not lost with members rotating off at the same time. Any vacancies that occur during this period will be filled via a nomination process. The Oversight Group may also be disbanded at any time if Te Whatu Ora believes that the objectives have been fulfilled or that the Oversight Group is no longer required. Additional members may be brought on to working groups as required in relation to the work programme. If a member misses more than two consecutive meetings they may be asked to reconsider their capacity to continue on the Oversight Group.
8. Meetings
Meetings will be quarterly and 90 minutes duration. The majority will be held via Zoom or Microsoft Teams Face-to-face meetings may be scheduled on occasions where the needs of the agenda determine that a lengthy face-to-face meeting is required and extraordinary meetings may be set up if necessary A quorum of X members will be required for a meeting to proceed (i.e. half of the total number of members plus one), assuming that there is appropriate representation in accordance with the agenda.
Subject matter experts will be invited to attend the Oversight Group as required on the agenda (for example representatives from the Pharmacy Guild or from the Intelligence, Surveillance and Knowledge Directorate in Manatū Hauora).
If a particular issue requires more focussed work, a specific working-group will be established to address the issue in more detail and report back to the Oversight Group. This may include coopted representatives from outside the Oversight Group who have who have expertise relevant to the specific issues being addressed
Apologies must be communicated to the Chair and coordinator of the Oversight Group in advance of the meeting. Substitutes are generally not encouraged to minimise disruption of continuity, however, can be invited at the discretion of the Chairperson and the member who is unable to attend.
Payment of meeting fees will be offered to consumers and other representatives who may not be funded by a workplace or organisation to take part in the Oversight Group. Members employed by government agencies or crown entities are not eligible for additional remuneration. Other members may be eligible for a daily fee paid on a pro-rata basis in accordance with guidance from the State Service Commission. This fee will cover preparation for and participation in meetings. Additional expenses incurred by any member in the course of fulfilling their membership responsibilities will be reimbursed on an actual and reasonable basis and receipts are required.
Decisions will be made by consensus or if consensus cannot be reached by majority. If consensus is not reached, dissenting positions are to be recorded and included in formal advice or viewpoints.
Members are expected to disclose any potential conflicts of interest at the start of each meeting. If situations of conflict should arise between two or more Oversight Group members, an attempt to resolve the conflict among these members should be attempted in the first instance. If this fails, the issue must be raised with the Chair.
Refer to Appendix 1 for a list of the members in the Oversight Group.
Name
Area of representation
Community Alcohol and Drug Addiction Services
Public health
Māori health workforce Te Aka Whai Ora
Consumer representatives
Hepatitis C nurses
General practitioners
Hospital specialists
Hepatitis C regional coordinators
Department of Corrections
Institute of Environmental Science and Research
Role and organisation