Most people with hepatitis C can be cured in as little as eight weeks with a course of tablets. Despite this, many Australians with hepatitis C are yet to undertake the treatment and be cured. The main target of the project are people who know they have a current hepatitis C infection and have not started treatment.
Participants are required to re-test for hepatitis C and must receive a positive result before being referred for treatment. All participants will be compensated $105 for taking the test.
In addition, participants may be chosen to receive a reward payment for commencing hepatitis C treatment. This randomly assigned cash reward will range from smaller amounts up to $1000. The amount of cash reward offered will be randomly varied, with the variations providing data on whether there is a motivation “price point” – the level is enough to move participants to fill a prescription and start treatment.
All patients who complete treatment will receive a $75 compensation on receiving a sustained virological response (SVR) at four weeks post treatment. It is unclear if there will be follow up with participants who re-tested positive in the project but did not go on to treatment.
The primary healthcare prescriber may also be compensated. The GP “co-incentive” amount will depend on whether they are the participant’s own GP or are a “default GP” who is already part of the project.
People who have a positive hepatitis C result at least six months ago, but haven’t been on treatment, can sign up for the Motivate C project. Adults who believe they have hepatitis C and who haven’t been tested for the last four weeks are also eligible to participate.
Participants need a mobile phone to take part in this study as the whole process is SMS-based. Those who are interested will need to self-register via their phone. They will be allocated a navigator who will guide them through the process. The process is personalised and confidential.
The navigator, who is trained in clinical and consenting practices, will also act as interface between the project and the participant-nominated prescriber. Participants who don’t nominate their own prescriber will be referred to one by the project.
The project hopes to recruit participants through GPs and nurse practitioners who, they say, are “critical to the success” of the Motivate C project. Project organisers are urging healthcare professionals to review their patient records to identify people who have tested positive for hepatitis C but have not gone on treatment, let those patients know about Motivate C, and encourage them to sign up for the study.
Primary care providers are encouraged to refer the following people to the Motivate C project:
The University of Sydney is leading this national project in collaboration with researchers, healthcare providers and GP experts within the hepatitis C field. Funding for the project is provided by the Australian Government’s Medical Research Future Fund. The Motivate C study is approved by the Sydney Local Health District Human Research Ethics Committee (2022/ETH01681) and is now recruiting participants.
For more information about Motivate C visit: https://motivatec-project.sydney.edu.au/
]]>Come February 2024, the Community News publishes its 100th issue. In this retrospective, we take a look at how the publication has evolved over the years.
Hepatitis SA veterans, Deborah Warneke-Arnold and Fred Robertson remembered the early, heady days. “We had a tiny room at DASSA on Fourth Avenue, one project officer, Colin, and a one-day-a-week admin person, Julie,” Deborah recalled. “We were getting calls from people wanting more information. We thought, we’ve got all this information from the readings we’re doing, we should share it with a newsletter.”
The Hep C Community News started with an editorial group of five and enthusiasm jumping off its eight pages. (Read issue #1) Sections included Book Review, Real Life, Diet, and a Dear Doctor column with replies from Dr Robina Creaser, and occasionally, other relevant specialists.
The newsletter was rich with news on the Hepatitis C Council SA (HCCSA) and its support group activities, as well as information on transmission, diet, treatments, legal rights and mental health.
Deborah joined the Council in 1997 and hadn’t looked back since. By mid-1999 she was editor of the Community News. “Doug Mellors [the writer behind Doug’s Desk] taught me how to look up information. I’d go to the Barr Smith library and spend hours there reading up on the latest research. I was so proud of my membership card. I’d be there, putting my head down, reading as much as I could, hoping people would think I’m a student,” she said, laughing.
“I was editor from issues 9 to 20. I learnt all my computer skills from working at the Council, especially on the newsletter – touch-typing and layout with Publisher. It was very much a community learning together.” (More Deborah’s story #16.)
Editorial group members working alongside Deborah included Doug Mellors, Sharon Drage, and Fred Robertson, with proofreading support from acting manager Leslie Whiteman. Subsequent issues listed HCCSA Coordinator, Kerry Paterson, as proofreader.
Deborah remembered key events reported in the magazine. One such highlight was the first Hepatitis C Awareness Day in SA. Issue 12 (Autumn 2000) reported on the Awareness Day launch by the Minister for Disability Services, Robert Lawson. Adelaide Mayor, Jane Lomax-Smith, facilitated a lived experience forum and Equal Opportunity Commissioner, Linda Mathews, launched a pamphlet jointly produced by HCCSA and the Commission. There was a pre-Awareness-Day education session run by HCCSA, the Drug and Alcohol Services Council, Marion Youth Centre and COPE; and HCCSA launched its brand new website on that first Awareness Day.
Remarkably, we learn from issue 44 (July 2009), that Dr. Jane Lomax-Smith again launched the Council’s hepatitis C awareness campaign, by then part of the World Hepatitis Day campaign. This time she was doing it as Minister for Mental Health and Substance Abuse, on behalf of Health Minister, John Hill. And coincidentally, HCCSA’s revamped website was also launched that day.
Perhaps the most striking difference between the very early Community News and now, is the lively community engagement: questions to the doctor, angry letters, thank you letters, personal stories and so on. The sort of thing that happen online these days.
Even within the first few years, however, as the information in the magazine got more comprehensive, even though letters to the editor continued to come in from time to time, spontaneous communication declined as the content answered questions before they were asked.
“The changes in the Community News pretty much reflect the changes that had to happen with the Council,” said Fred who was on the editorial and management committees, and had contributed many a book review as well as articles on complementary therapy.
“The changes in the organisation were inevitable – it’s a natural growth and progression from an ad hoc community group to a professional NGO that can influence decisions that affect the community.”
He remembered turning up at the Council for information and feeling so welcome that he joined as a member and a volunteer. “It’s different now but it also means things are done with professional staffing, with greater awareness of rules and guidelines which means as an organisation we can do more,” he said.
Fred said the Community News has become more professional in presentation and content, as befits the flagship publication of a peak service organisation. “We lose some spontaneity in the process, but we also gain a lot – more credibility, access to decision-makers, more funding and greater reach,” he added.
There is no formal archive recording the history of Hepatitis C Council SA – now Hepatitis SA – but the Community News does a pretty good job filling that gap.
Its 99 issues to date chart the organisation’s growth from a small group of committed individuals with varying skill levels, to a peak organisation with highly skilled staff providing on-going support and services, reaching more people and having input into state-level decision-making that affects the hepatitis sector and community.
Read all 99 issues (bit.ly/hcnstack).
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Launched in March 2023, the Roadmap identifies priorities needed for the next two, five and ten years to reduce disease burden and rate of liver cancer, and improve outcomes and survival rates for Australians affected by the disease.
Among the actions recommended are:
Liver cancer is the fastest growing cause of cancer-related deaths in Australia, having rapidly increased in incidence and deaths in the last 40 years. The incidence of liver cancer has risen from 1.8 per 100,000 in 1982 to 8.7 per 100,000, and this trend is expected to continue unless steps are taken to prevent the development of the disease in people who are at risk.
While there are many types of liver cancers, the bulk of liver cancer cases are HCC. This means A significant proportion of liver cancers can be prevented by eliminating the transmission of hepatitis B and hepatitis C which are the leading causes of the HCC.
Early detection of hepatitis B and hepatitis C infection followed by treatment to cure for hepatitis C and monitoring with appropriate clinical management will go a long way towards reducing the development of liver cancer in people currently living with the viruses. Management of close contacts, with vaccination where applicable, and other harm reduction strategies to reduce the transmission of these two viruses will ultimately contribute to the lowering of liver cancer incidence.
Liver cancer risks also include behavioural and metabolic factors that are associated with other chronic diseases. They include excessive alcohol use, tobacco consumption and the excess accumulation of fat in the body. Accordingly, the Roadmap recommends the funding of preventive health actions for non-communicable diseases, especially around tobacco control.
… improving access for these communities by providing culturally-friendly support to help patients who are receiving HCC care, navigate the health system.
Recognising the higher risk of liver cancer in some population groups, the Roadmap has called for targeted education campaigns to increase liver cancer awareness in Aboriginal and Torres Strait Islander communities and culturally and linguistically diverse groups. In addition, it is calling for improving access for these communities by providing culturally-friendly support to help patients who are receiving HCC care, navigate the health system.
The Roadmap also pointed out the need to link collected data to surveillance and screening of liver cancer. Applying data around patient characteristics and socio-economic factors to liver cancer diagnoses and outcomes will support better identification of people at higher risk of developing liver cancer and facilitate measures to reduce liver cancer incidence and improve outcomes.
Cancer Council SA (CCSA) Manager of Prevention and Advocacy, Christine Morris, says CCSA welcomes the launch of the Roadmap and supports the Priority Actions outlined in the document.
“We are building relationships with key organisations to support activities that are already underway,” she said. “In future we will broaden our work in liver cancer control to focus on prevention, immunisation, advocacy and support. We hope to achieve this by building effective partnerships and working in culturally appropriate ways.”
She pointed out that CCSA’s current key services are in line with the Roadmap’s Priority Actions. This includes its confidential information and support line Cancer Council 13 11 20.
“It is open to anyone. People living with cancer, their families, carers and friends, the public, workplaces, and health professionals,” she added. “We can talk to you about the effects of specific types of cancer and how to cope with treatments and side effects, provide a listening ear for you to share your experiences, provide emotional and practical support and link you to a range of support services, such as legal and financial assistance and support groups.”
In addition, CCSA provides free, non-judgemental and confidential Counselling services for patients, their family and/or carers, including bereavement counselling. It also offers low-cost accommodation for patients and their carers travelling from regional areas to Adelaide for treatment and cancer related appointments.
The Roadmap to Liver Cancer Control in Australia was developed and published by Cancer Council Australia and funded by the former Department of Health, now the Department of Health and Aged Care.
]]>“I found out I had hepatitis C in 2000 when a diligent and insightful GP decided to test me for it after she discovered I had hepatitis B back in 1975. I’d cleared the hep B then and didn’t think about it anymore. Didn’t know I had hep C,” she recalled.
“Well, when I got my hep C diagnosis, I started worrying about how long I would live for, and worried about passing the virus to other people. I’d look at pictures of the virus and thought it looked really scary.”
Because there was no effective cure back then, Maureen looked into, and tried complementary therapies. “I tried acupuncture, herbal remedies… with no results,” she recounted. Then, in 2009 because she had liver cirrhosis, Maureen was put on Pegasus.
“That went horribly wrong – I almost died.”
She kept a visual diary during the first treatment but had to stop because she became too ill. She had ended up in intensive care for nine days with double pneumonia and septicemia. “My bone marrow had stopped producing the vital blood cells to fight the good fight for me. Remarkably I survived, after I was not expected to,” she said.
“I had to go to St Margaret’s hospital to learn to walk again. My memory and comprehension was really bad.”
In 2011, she began a series of five self-portraits documenting her difficult journey to recovery. She named the series Waking the Dead. In her artist statement for an exhibition where her this series was presented, she said: ‘Waking the Dead 1-5′ documents my struggle to be present in the world as my consciousness dragged itself to the surface … I had to relearn thinking, comprehending, remembering, doing and to be able to stand up and walk again.
“I was attending an art group in Stepney, learning painting. The artwork was my way of processing all that,” she explained. “The series of five portraits was me coming back to life. It was almost like a spiritual experience.”
In 2015 she had a call from the Flinders Medical Centre offering her to be part of a trial of new direct acting antiviral drugs.
“The new treatment was different. The only side effect I had was insomnia. My asthma played up a bit, but it was manageable. I was able to continue to go to work.”
Life post-cure was… a tremendous relief. It was wonderful knowing that I’m no longer infectious, able to pass the virus on to others.
For Maureen, the difference in life pre and post cure didn’t relate much to how other people treated her, but more to how she felt about herself.
“I had internalised my stigma because I felt I was stupid … blaming myself. I thought, being a nurse, I should have taken more care. Now I’m cured, I don’t feel that self-blame anymore. I can put it all behind me.
“I hadn’t encountered much stigma overtly, from others. Mostly support in fact. I discussed my hep C with friends and family when I was first diagnosed. They only gave me support.
“Initially I chose not to disclose to my workplace that I had hep C. However, the Pegasus treatment went for 48 weeks which meant I had to take a year’s leave without pay due to the severity of the side effects.
“Even though the first treatment went horribly wrong, and I ended up in hospital for 10 weeks, the time off work and recovery really helped with my burn-out from work.
“After the horror of my first treatment, I had decided to take a positive attitude and accept that I had to learn to live with this chronic disease.”
“Life post-cure was… a tremendous relief. It was wonderful knowing that I’m no longer infectious, and not able to pass the virus on to others.”
A nurse for 47 years, 38 of them in mental health, Maureen continued working after clearing hepatitis C, until the COVID-19 pandemic hit.
“I took a couple of weeks off, and kept on taking more,” she said with a laugh. “That’s when I retired from nursing – in July 2020.”
After a three-year hiatus, unwinding and reviewing her new life, she’s ready to get back into work – not as a nurse but in other areas that draw on her lived experience and her relationship with art.
I was trained in acceptance and commitment therapy, and used that to give people skills to managing their own emotions and life challenges. Art was part of it…
“As a mental health nurse, I worked in many areas and in my last ten years, I was part of a SA Health community psycho-social rehabilitation team. We provided group programs on living skills, psycho-education, healthy living, fitness, recreation, youth programs, art, liaising with further education and community centres and many more activities. We also worked with the inpatient unit Cramond Clinic and an NGO return to work program.
“I was trained in acceptance and commitment therapy, and I used that to teach people skills to manage their own emotions and life challenges. Art was an important part of rehab as a way of looking at the world, identities, and so on. The people I really enjoyed working with were the carers.
“Art is a good way to help people process their experiences and emotions and being with yourself. A way to engage with people. A very good mindful exercise.”
In the three-year break, Maureen reviewed the paintings that she had done on her journey, and decided to set up a studio so she could paint more and run workshops from it.
She believes art is for everyone, not only those who are “artistic” in the conventional sense. “It can work for people who may not be usually interested in art,” she explained. “Like creating mandalas, for instance… it’s a way to engage with people, get people motivated. It can also be an outlet.”
Maureen said looking at her artwork brought back difficult memories but also gave her direction for the next chapter of her life.
“Emotionally it was a really difficult time. Hep C was such a big part of my life for so long. and I didn’t know for so long that I had it. Having access to the new treatment was really life-changing for me and clearing the virus was one of the best things that happened to me.
“When I look at the artwork it brings it all back and gives me a stronger resolve to make a contribution with my life.”
View more of Maureen’s artwork here.
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The Education team ran several sessions in July and August, reaching at least 200 people from diverse communities.
They included the Aboriginal community at Maringga Turtpandi, the staff, women’s group and adult education classes at Community Access and Services SA (CAaSSA), English language students at TAFE Gilles Plains, as well as the Filipino community in the Riverland and in Adelaide with the Filipino Community Association.
Hepatitis SA Educator Shannon Wright said they had highly positive feedback at all events. “One Maringga Turtpandi worker said the session they attended had been the best education session they’ve had,” she recalled.
“Another worker said they used to be so scared of people with those viruses, and it was really good to hear about this to reduce stigma. They also appreciated our positive speaker Kath’s candour and courage in sharing her lived experience story.”
Most participants at the community sessions were able to answer questions about hepatitis B and hepatitis C, and after the sessions many confidently went on to take part in our online quiz. And participants at an English-language class at CAaSSA were pleased to hear that the quiz was available in languages other than English.
In addition, Chen Bin, Viral Hepatitis Nurse from Lyell McEwan Hospital, presented an interactive session with the Chinese community. Hosted by the Chinese Association of South Australia, the session was followed by a lively Q&A. All of the 48 participants said they had learnt new things about hepatitis B and would definitely attend a similar activity in the future.
Volunteers at Hope’s Café at Uniting Communities Norwood collected almost 60 entries, discussing the quiz questions with individual customers, many of whom were from disadvantaged communities.
On World Hepatitis Day itself—28 July—we had an all-day community information stand at the Arndale Shopping Centre, where we tested people for hepatitis C and spoke to others about hepatitis B vaccination, hepatitis C testing and treatment, and encouraged people to participate in the online quiz.
We also received 46 entries for a prison-specific hepatitis C quiz run across four sites including Port Augusta Prison, Mount Gambier Prison, Cadell and Mobilong. Participants called the Hepatitis SA Helpline to give their answers. In addition, there were internal competitions in the Adelaide Women’s Prison and at Port Lincoln Prison. Prizes differed at each site, and included Toblerones, notepads and pens, toiletry packs, Nescafe coffee sachets, beanies and sunglasses.
In 2023, Hepatitis SA had a go at getting public buildings to light up green—chosen as the colour of life, vitality and progress—on World Hepatitis Day. Of the 15 venues contacted, three generously agreed to “glow green” on or close to 28 July. Thank you to Adelaide Oval, Parliament House, and Unley Council. The Unley City Council was especially supportive backing up the green lights with social media messages.
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Major religious organisations were early supporters with a statement released in May 2022. This gave impetus to the formation of the Multicultural Australia for the Voice, alliance with 178 multicultural organisations signing a joint resolution.
These communities include SACOSS, Hepatitis Australia, NUAA, NACCHO, Diabetes Australia, Cancer Councils and faith-based charities The Salvation Army, Anglicare Australia, Baptist Care Australia, Catholic Social Services Australia, St Vincent de Paul Society and UnitingCare Australia.
Professional bodies ranging from Law Societies, the College of General Practice, the College of Surgeons, the Nursing Federation and the Institute of Architects are also on board.
Among the many and varied reasons given, top on the list is improved outcomes for Aboriginal and Torres Strait Islander people. This came through clearly in health services where organisations cited better health outcomes as a reason for supporting the Voice.
Hepatitis Australia viewed it as “core business” in Australia’s efforts to eliminate viral hepatitis.” The Cancer Council SA saw it as a reform that would align with their strategy and purpose to “reduce the rate and impact of cancer for all South Australians.”
The Royal Australian College of General Practitioners (RACGP) said, “The Voice to Parliament will help drive changes to improve health outcomes for Aboriginal and Torres Strait Islander peoples and address the inequity in our health system”, and the Australian Medical Association (AMA) saw it as “a tangible opportunity to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples”.
The National Aboriginal Controlled Community Health Organisation (NACCHO), pointed out, “Research clearly shows the links between constitutional recognition and improved health outcomes.” It cited as example, the successful management of COVID-19 in communities, where they were consulted and listened to.
The other common theme is that the Voice is a just and reasonable request. Some direct quotes include:
Others saw it as part of the reconciliation process, accepting the Uluru Statement’s call for Voice, Treaty, Truth, with Voice is the first step.
Less common but just as compelling reasons cover historical perspective, trust, personal lived experience, acknowledging the First Nations stewardship of the land over 65,000 years, and the negative consequences of saying “no”. These were often from people of migrant backgrounds.
“We have confidence and trust in our indigenous brothers and sisters,” said one.
“Because I know what it is like to be displaced,” said another.
Another reminded his viewers that “for 65,000 years they have been caretakers of this land”, with another one declaring, “By voting yes, I will be standing with them reclaiming what has always belonged to them”.
One of the most thought-provoking might be a simple question put by someone who was initially unclear about his own position, “If my vote can change the lives of First Nations people by even a tiny, tiny bit, then why wouldn’t I vote “Yes”?”
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“Can I talk to you, ask you something?” she continued. She needed to get back to the hospital where she worked; her lunch break was almost over, so we spoke as she walked. Shui* told her story and gave me her contact details.
Her nephew had just got engaged and wasn’t sure if he should tell his fiancé’s family about his positive hepatitis B status. She was worried that the family, if they knew, would oppose the relationship.
She was looking for a hepatitis B friendly doctor who spoke their language, a GP her nephew could consult, and his fiancé’s family could talk to.
In communities from regions of higher hepatitis B prevalence, such stories are not unusual. The adverse outcomes of chronic hepatitis B would be familiar, and the fear of transmission – particularly to children – would be real, especially where childhood hepatitis B vaccination is not universal.
For some, a hepatitis B diagnosis must seem like a huge barrier to a normal life. What many don’t realise is that in Australia, with proper management, it is possible to minimise the impact of the virus and live a normal life. The two key tools are:
Although there is currently no cure for hepatitis B, there is treatment to manage the virus. While not everyone with hepatitis B needs treatment, six-monthly liver checks and blood tests will ensure that treatment can be given without delay, if and when it is needed.
The easiest and best way to protect people close to you is a safe and highly effective vaccine available to people of all ages. For most people three doses over six months will provide life-long protection.
If immunity does not develop after three doses, extra doses may be needed. Your family and household could be eligible for free hepatitis B vaccinations. (https://bit.ly/hepbvax-eligibility-sahealth.)
Hepatitis B is transmitted via blood and sexual fluids; babies do not inherit hepatitis B through their parents’ genes.
Mothers with hepatitis B may pass it to baby during the birth, but this can be prevented with a dose of vaccine and Immunoglobulin given to baby in the first four to twelve hours after birth. Immunoglobulin is a blood product with hepatitis B antibodies.
If needed, mothers with hepatitis B may be given treatment during pregnancy to reduce transmission risk to baby. Unless mother’s nipples are bleeding, breastfeeding is perfectly safe even if mother has hepatitis B.
In addition to regular monitoring, a healthy diet and keeping as physically active as possible will help maintain liver health. Also important is limiting fat and alcohol intake as these are damaging to your liver.
If you are not immune to hepatitis A, get a vaccination. Any additional liver infection would put further strain on your liver.
With proper care hepatitis B should not stop you from living a full, healthy life with your family.
And in case you’re wondering, we found a friendly GP who spoke Shui’s language. Despite having closed books, he made an exception and agreed to see them.
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Briefly, the proposed interventions are:
Regulated provision of sterile injecting equipment to people who inject drugs – commonly known as Needle and Syringe Programs (NSP) or Clean Needle Programs (CNP). Evidence show that CNPs work to reduce blood-borne virus transmission and is considered best practice with evidence from 10 countries showing they work just as well in prisons as they do in the community.
The statement pointed out that the lack of regulated access to sterile injecting equipment is associated with new blood-borne virus infections and reinfections among prison populations despite the provision of direct-acting antivirals. Regulating access to new sterile needles is also an important strategy in preventing injecting-related injuries and disease and thrombophlebitis.
Overdose prevention sites that provide a safer place for people to inject drugs under the supervision of health professionals where overdose can be quickly reversed. They provide opportunities for contact and referral to other services. Evidence show they reduce the risk of overdose and improve access to care.
Needle cleaning agents – Bleach is an effective agent against the hepatitis C virus and HIV when it can be used properly to clean needles and syringes. Where people in prisons cannot access clean and sterile injecting equipment, needle cleaning agents should be provided.
Naloxone – Evidence shows that take-home naloxone programs which train participants to recognise overdose and administer the opioid reversal drug, reduces overdose deaths both in prison and in the high-risk period following release from prison.
Peer-led education and programs – Peer educators a more credible and trusted source of information for people in prison. Extensive research shows that education programs in prison are more effective at reducing risky behaviours when developed and delivered by peers. Peer support programs and peer workers provide emotional support and practical information, such as supporting engagement in testing.
Opioid Agonist Treatment (OAT) is a cost-effective treatment that is associated with reductions in harmful drug use, blood-borne infections and death, both in the community and in prison (56-58). OAT has also been found to improve prison safety and reduced rates of re-offending among people in prison (3). Combined use of OAT with needle syringe programs is more effective at preventing new blood-borne virus infections than just providing OAT alone.
Blood-borne virus (BBV) screening should be offered to everyone entering prison and then yearly and be voluntary. International research suggests that opt-out systems where screening is standard practice for everyone rather than opt-in, is best for maximum take-up of screening, as long as people are adequately informed of their right to refuse.
Hepatitis B virus (HBV) vaccination of all people in prison is recommended by the Australian government. HBV immunisation reduces the pool of people infected with HBV thereby reducing the likelihood of transmission.
Hepatitis C virus (HCV) treatment – Direct Acting Antivirals (DAAs) are an approved medication that have special prescribing status so can be accessed by people in prison under Medicare. The provision of unrestricted access to DAAs has cured nearly half of all people living with hepatitis C in Australia (from 2016 to 2020) and has reduced incidence of new hepatitis C infections in Australia.
However, DAA treatment is less effective as prevention strategy in situations where there are high rates of risky injecting behaviour and other harm reduction is unavailable. It needs to be combined with effective primary preventative measures such as needle exchange programs to achieve hepatitis C elimination.
HIV prevention and treatment – Pre-Exposure Prophylaxis (PrEP) is a medication that prevents HIV acquisition and Post-Exposure Prophylaxis (PEP) is a course of medication that can be taken after potential exposure to HIV to prevent acquisition. Antiretroviral Therapy (ART) is an approved medication to treat HIV. PrEP, PEP and ARTs are funded on the Pharmaceutical Benefits Scheme.
The Working Group in its statement said the recommended interventions have application for all people at risk of injecting-related harm, disease and death in prisons and hoped that the statement would assist policy makers at all levels of government in all jurisdictions to apply a broader lens to harm reduction and to understand why a comprehensive response is needed.
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The statement outlines an evidence-based approach to reducing the spread of BBVs and other injecting-related harms in prisons. Calling on policy makers to act, Australian Alcohol and other Drugs Council (AADC) CEO and consensus statement signatory, Melanie Walker, said. “The spread of BBVs in prison settings is currently like a hole in the rabbit proof fence of our National BBV and Sexually Transmissible Infections (STI) Strategies and this consensus statement outlines how we can work together to fix this gaping hole.
drug use and the spread of BBVs in prisons affect everybody because people who leave prison go back into the community to their families and friends
“The number and breadth of organisations represented by signatories to this consensus statement is
significant. What we all agree on is that it’s really important that the full range of harm reduction options that are available in the broader community are mirrored in custodial settings if we are to successfully achieve public health outcomes for all.”
Director of the Drug Policy Modelling Program at UNSW Sydney and consensus statement signatory, Professor Alison Ritter, AO, said drug use and the spread of BBVs in prisons affect everybody because people who leave prison go back into the community to their families and friends.
According to experts behind the statement, Australia has committed to eliminating hepatitis C by 2030, but right now prisons are the weakest link in the strategy to reaching this goal.
Injecting drug use can result in a number of fatal or serious harms including overdose, BBV transmission and injecting-related injuries. But all three of these harms can be reduced and/or prevented through effective harm reduction programs.
Harm reduction involves helping people to improve their health through providing practical and non-judgmental support. This involves meeting people where they are at, acknowledging that abstinence is not the only way to reduce harms arising from drug use.
“There is a wealth of evidence that supports the effectiveness of harm reduction programs,” said Prof.
Ritter AO. “Harm reduction is effective at reaching the most marginalised members of society who would otherwise not access healthcare and it has also been proven to improve prison safety for both detainees and staff.”
Prisons are high-risk environments for the spread of BBVs due to the lack of access to new and sterile injecting equipment, which results in people sharing unsterile equipment. Consequently, people in prisons continue to experience higher rates of hepatitis C and HIV than the general population.
“Despite Australia being an international leader in the provision of Needle and Syringe Programs to the
general public, we have fallen woefully behind by excluding people in custodial settings from accessing this vital and lifesaving service,” said Prof. Ritter AO.
Prison settings also provide an opportunity to engage people who have a history of injecting drug use with health and well-being services that they may not have previously been able to access in the community.
These interventions not only make prisons safer, they also help to ensure better health outcomes for the
communities to which people are returning after their release.
From a public health perspective it doesn’t even matter whether you care about prisoner health or not … failing to address the spread of BBVs in custodial settings is a broader public health concern that directly affects Australian families and communities.
Calling on policy makers to act, the statement pointed out that Australia won’t be able to achieve critical public health goals like eliminating hepatitis C when it’s ignoring people in prisons.
“From a public health perspective it doesn’t even matter whether you care about prisoner health or not. The fact is that people come in and out of prisons and go back out into the community – so failing to address the spread of BBVs in custodial settings is a broader public health concern that directly affects Australian families and communities,” says Ms. Walker.
The consensus statement will provide assistance to policy makers at all levels of government in applying a broad and comprehensive approach to harm reduction in, and outside of, prisons.
The Working Group is a national cohort of health practitioners, researchers, sector representatives and advocates and is convened by the Social Policy Research Centre’s Drug Policy Modelling Program at UNSW Sydney.
Read the full consensus statement.
Aboriginal Health Clinical Director at Moorundi, Beth Hummerston, said hepatitis C point of care testing will work well at Moorundi’s clinics, particularly in Murray Bridge, because it will soon become a Clean Needle Program site.
“Community feedback was that the current options available to access clean needles are not places where people feel comfortable going,” she explained. “Having a Clean Needle Program available may provide opportunities to talk to people about hepatitis C testing and is a way of addressing disparities in health services for people who likely don’t access health services regularly.”
Beth said whether testing is provided on-the-go, as part of other services, or on specially organised clinic days depends on community response.
“We have very experienced Aboriginal Health Practitioners who can perform the testing services independently, so we would be able to offer point of care testing as need and opportunity arises, in response to circumstances,” she said.
She said Moorundi hopes to eventually take the point of care machine to other communities where they have clinics at Raukkan and Victor Harbor.
Moorundi is one of ten South Australian sites participating in the HCVPOCT program. Metropolitan sites include drug and alcohol services, prisons and local health networks. Besides Moorundi, other regional sites include Pangula Mannamurna Aboriginal Corporation in Mount Gambier and the rural city of Murray Bridge.
Viral Hepatitis Nurses Rosalie Altus and Lucy Ralton from the Southern Adelaide Local Health Network (SALHN) are planning a series of testing clinics at the local community venues, beginning mid-March.
“Murray Bridge is an area with a lower socio-economic profile,” said Lucy.” Compared to metropolitan Adelaide, it has higher unemployment and people looking for work as well as people with disability. It’s also been deeply affected by drug use in recent years. These are factors associated with higher risk of hepatitis C infection.”
As part of the testing campaign, Hepatitis SA educators will provide free education sessions to workers in mental health care, community corrections, drug and alcohol services, other community services and GP networks. The sessions cover basic hepatitis C information, risk factors, diagnoses, treatment, the national point-of-care testing program and its roll out in Murray Bridge.
The Viral Hepatitis Nurses will coordinate with services which express interest in hosting the point-of-care testing clinics for their clients and work out the best time and format for each clinic location.
“It takes time for relationships with key local people and services to develop,” said Lucy. “We plan to trial regular sessions for six months, see what the uptake is like and adapt the where, when and how as we go so that we can optimise the opportunity to bring hepatitis C point of care testing to people in the Murray Bridge area.”
Point-of-care testing is done by taking a small drop of blood with a finger stick and processing it in a portable GeneXpert machine that provides results within an hour. The portability of the equipment means testing can be taken to the community, to where people go regularly for other services.
Hepatitis C can be cured with tablets taken daily for eight or twelve weeks. Close to 100 per cent are cured and re-treatment options are available to the very small percentage of people for whom treatment did not work the first time.
People who test positive at Moorundi run clinics can be booked with the Service’s GPs. “This will ensure the experience is culturally comfortable and non-intimidating,” said Beth.
Those who test positive by the Viral Hepatitis Nurses can be immediately referred on for treatment which can be managed by their general practitioners. For those who don’t have a GP, alternative arrangements can be made.
“Metro-based Viral Hepatitis Nurse Consultants are experienced in working with individuals remotely to enable them to access hepatitis C testing and treatment,” Lucy explained. “We can arrange for blood tests, help interpret results, discuss results with patients over the phone, diagnose a hepatitis C infection and arrange for prescriptions if needed.
“We also check for other pre-treatment issues and support people through the treatment process and organise post treatment testing.
“These days, people don’t have to travel to a major centre to check their hepatitis C status or to get treatment. In South Australia, they can just call a Viral Hepatitis Nurse.”
The National Australian HCV Point-of-Care Testing Program is run by The Kirby Institute, UNSW Sydney and the International Centre for Point-of-Care testing at Flinders University. It is funded by the Commonwealth Department of Health.
The Program aims to establish a network of sites to scale up point-of-care HCV testing in settings which provide services to people at higher risk of hepatitis C, in order to increase testing and linkage to treatment.
A total of 93 sites have registered including 27 prisons and 10 Aboriginal Community Controlled Health Organisation (ACCHO) sites. New South Wales leads the way with 44 sites, followed by Queensland with 23 and South Australia punching above its weight with 10.*
At the time of writing, 53 of the POC registered sites are operational and 139 people have been trained to operate the testing machines. Over 7,780 HCV point-of-care tests have been conducted via the Program, 7,020 people tested with 965 positive and 715 initiating treatment.
The HCVPOCT Program is the first internationally to evaluate whether increasing point-of-care HCV RNA testing will improve treatment uptake among people at-risk of HCV.
To find out more about getting point of care testing in South Australia, call the Hepatitis Sa Education Team on 1800 437 222.
For more on the national HCVPOCT program, call 02 9385 0900 or email hcvpoct@kirby.unsw.edu.au.
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