Hepatitis C New Zealand

May 25, 2009

Increasing Access to Hepatitis C Treatment in New Zealand

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , , , , , , — admin @ 10:57 am

New Zealand Ministry Of Health Stock take of Existing Services May 2007 May 2008

“often with additional commentary” for Sara and Sue

The Minister of Health finally released a copy of  a stock take of hepatitis C services in New Zealand. My copy is the appendix of the new Hepatitis Plan to be released by the Ministry soon.

It covers a lot of the detail of Hepatitis C Treatment around New Zealand, it really is a lottery of care with some regions winners and others losers in the level of treatment available.

you can download a pdf  file of the report here  stock take of hepatitis C services

It answers questions

Referral

1. What are your guidelines for referral to secondary care for patients with hepatitis C?

2. Do you add any information to seek prioritisation?

3. What is on the referral form? Is there routinely provided an adequate history including recent LFTs, risk factors for HCV exposure, duration of infection, alcohol intake, how
long clean from IDU, etc?

4. Where are the referrals sent from primary care (Central Bookings Office, specific departments or individuals)? Who is responsible for sorting these? Who proritise referrals?

5. Which speciality units in your hospital will provide outpatient assessment and treatment for patients with hepatitis C: General Medicine, Infectious Diseases, Hepatology, Gastroenterology?

6. How are hepatitis C patients prioritised relative to other patients within the specialty and what are the factors used to prioritise hepatitis C patients (eg, acute hepatitis C,
probably cirrhosis, hepatoma, immunosuppressed, etc)?

7. What is the GP’s role in the process after referral?

8. How many referrals are returned to the GP due to low priority? What determines such “Iow priority” status?

9. Are patient referrals confirmed prior to the clinic day — by letter, phone?

10. What is the non-attendance (DNA) rate and what is the process following a DNA? How many times will DNA patients be rebooked? If DNA patients are discharged, are
they referred back to their GPs?

11. lf patients are not suitable candidates for treatment, refuse treatment or have undergone treatment but failed, are they discharged back to the GP?

Post-first assessment

12. Who conducts the initial new-patient assessment- specialist, registrar, house-surgeon or nurse? ls every clinic supervised by a specialist?

13. What tests are ordered at this initial assessment: LFTs, HCV-RNA, viral load, viralgenotype, ultrasound, liver biopsy?

14. How is the severity of liver disease assessed in people with bleeding disorders prior to treatment- biopsy (transjugular vs percutaneous), ultrasound, scintography, other?

15. What is done to prepare patients for antiviral therapy: What various activities happen between new-patient specialist assessment and commencing treatment:

16. ls a psychiatric assessment performed routinely on all patients prior to the decision on therapy? How is this done — subjective assessment? Objective score (eg, HADS
score)? Formal liaison psychiatry review?

17. Do patients receive information in preparation for treatment (re side effects, etc)? If so,what information and in what form? For example, clinic visits, written information, etc.

18. What testing do you do after first assessment? ie, genotype? viral load? biopsy?

19. What are the exclusion criteria for treatment: alcohol abuse/length of abstinence; injecting drug use; length of abstinence; methadone; cannabis; other?

Treatment

20. ls there a standard treatment protocol for hepatitis C that you follow?

21. In patients infected with HCV genotype 1 do you follow the “earIy stopping rule” for treatment, ie, if HCV-RNA level after 12 weeks has not dropped by more than two logs
from baseline level, is treatment stopped?

22. ln patients infected with HCV genotype 2 or 3, how many weeks treatment is administered?

General statistics

23. What is the total number of first time specialist appointments for patients with hepatitis C at your hospital annually?

24a. How many patients with diagnosed hepatitis C were referred to your unit in 2005/2006?

24b. How many patients with diagnosed hepatitis C were referred to your unit in 2004/2005?

25. What is the total number of patients [with hepatitis C] treated at your hospital annually?

26. How many patients are CURRENTLY on treatment for hepatitis C at your hospital?

27. What is the total number of follow ups, including nurse and physician appointments seen at your hospital annually?

28. How many patients with chronic hepatitis C were seen at your hospital between 1 January and 31 December 2006? Between 1 January and 31 December 2005?

Waiting times

29. lf someone with hepatitis C is referred this week from their GP, what is the approximate waiting time for an initial specialist assessment at your hospital?

30. What was the total number of patients with hepatitis C waiting for initial assessment as at 1 July 2006?

31. How many new hepatitis C patients were added to the waiting list in the last six month period?

32. What is the approximate time interval between receipt of initial referral from GP, to first time specialist appointment, to commencement of antiviral therapy?-

33. What are the factors that contribute to waiting times?

Other

34. What limits capacity?

35. Do you have a dedicated hepatitis clinic?

36. How many FTE nurses and physicians are allocated to hepatitis C treatment at your hospital?

37. Do you have online access to GPs’ laboratory results?

38. Do you make your laboratory results available o-line to GPs?

download the full report here

Looking forward to the answers to these regional health inequalities in the Hepatitis Plan to be released soon

Happy Birthday to the needle exchange in New Zealand 21 years old this year

Approximately 200 outlets around New Zealand provide new needles to injecting drug users and safely dispose of used needles. Around 3 million clean needles are distributed each year with many outlets also providing information and advice about preventing the transmission of blood-borne diseases and drug treatment options.

national manager of Needle Exchange New Zealand, Charles Henderson.

Speaking at an event on Tuesday to mark the 21st birthday of needle exchanges in this country, Mr Henderson said that, thanks to the programme, New Zealand has a lower HIV rate amongst its intravenous drug users than any other country, and that the spread of hepatitis B amongst injecting users has largely been contained.

“We’ve got the prevalence of HIV/AIDS down to just 0.3% and studies indicate there have been no new AIDS or hepatitis B infections within this group in recent years. This is quite remarkable considering blood-borne diseases are often rife amongst drug-using communities where needle-sharing is commonplace.

“It’s wonderful news for New Zealand as a whole because carriers of blood-borne diseases interact with others in their communities and can spread these diseases to people who don’t inject drugs.

“Over the last 21 years, the Needle Exchange Programme has saved thousands of Kiwi lives and millions of tax-payer dollars.”

You notice Charles (NENZ ) dos not mention Hepatitis C,  The needle exchange is not effective in stopping the spread of Hepatitis C, It is slowing the spread of Hepatitis C,  But how, can it work better to stop the growth and spread of Hepatitis C ?

The latest Household Drug Survey indicates 2 percent of New Zealand ers  inject or have injected drugs, including opiates and methamphetamine, in the last 12 months. This means 85,000 people are potentially susceptible to blood-borne diseases from drug use.

Estimating New Zealand Hepatitis C Figures By District Health Board Areas

We had a go at calculating the estimated numbers infected by HCV by district health board areas I used a conservative estimate of .8% of population being infected, here is what I calculated using 2007 figures.

DHB populations are approximately: Estimate of 0.8% population HCV
Number with HCV
DHB Population (000s)
Northland 154 1232
Waitemata 516 4128
Auckland 439 3512
Counties Manukau 468 3744
Waikato 355 2840
Bay of Plenty 204 1632
Lakes 102 816
Tairawhiti 45 360
Taranaki 107 856
Hawke’s Bay 153 1224
MidCentral 165 1320
Whanganui 63 504
Hutt 141 1128
Capital & Coast 282 2256
Wairarapa 39 312
Nelson Marlborough 135 1080
West Coast 32 256
Canterbury 491 3928
South Canterbury 55 440
Otago 185 1480
Southland 110 880
Source: Statistics NZ population projections, Sep 2007. 4241 33928

I just wanted to get a idea of the scale of the problem I used similar figures to the Hepatitis C infection in New Zealand: Estimating the current and future prevalence and impact July 2000.

Looking forward to seeing the new Hepatitis C Plan in the next few weeks the Hepatitis C Plan will hopefully address the problem areas from the Stock take report

Topper Headon (Clash)

Topper talks about his year on treatment and how he beat the hepatitis C virus

clean and healthy post hepatitis C treatment , a great short video

Best of Health

www.hcv.org.nz

May 18, 2009

New Zealand Hepatitis C, World Hepatitis Day Are you the 1 in 12?

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , — admin @ 5:53 pm

New Zealand Hepatitis C, World Hepatitis Day

Are you the 1 in 12?

World Hepatitis Day Tuesday May 19 2009 .

Apologies  to the New Zealand Hepatitis Foundation , Thanks for the update John  ”

Hepatitis Foundation of New Zealand

“On your blog page dated 18 May 2009 you stated that “here in New Zealand the Hepatitis Foundation has been in charge of world hepatitis day publicity this year”. You also go onto say that you pretty much missed the ads on TV.

For clarification the Hepatitis Foundation of New Zealand has not been in charge of publicity in NZ for World Hepatitis Day. We as a an organisation have not been in contact with any other organisation nor have we collaborated with publicity. The ad you are referring to on Prime TV is the responsibility and sanctioned by Bill Jang, Hep C Support Group. The Foundation sent out a media release as you  are aware of and the poster, no ads on TV.

Therefore i would appreciate that you retract this statement from your blog site and print the correct information.

Best wishes

John Hornell
Chief Executive Officer
Hepatitis Foundation of New Zealand  ”

publicity this year.

Hepatitis C Treatment in  New  Zealand Survey

Waiting for a complete set of replies from all DHB’s District Health boards before posting them all up, hopefully early June should have them online.

Biopsy for Hepatitis C in New Zealand ?

To clarify from the last blog post about Biopsy for Hepatitis C in New Zealand.

“I missed the news but apparently it is no longer mandatory to have a liver biopsy before treatment can be accessed. I will try and confirm this but that is what we were told.”

Had some great feedback on this which I have made anonymous as I’m unsure if it was to be attributed or not? Thanks for the feedback.
A professional contact sent us this, “I contacted leading  NZ specialist expert to clarify who needs a biopsy and who doesn’t.   Here is the response:
“We have never needed a biopsy for Gt 1 or HIV infected or haemophilia.  Only change is for Gt 2 and 3 where now Peg/RBV is available to all rather than just those with severe fibrosis.”

In the past only G2/G3 who has severe fibrosis could access funding, therefore for this to be determined, a liver biopsy was needed.  The new funding for treatment now includes all G2/G3 hep C patients; hence a liver biopsy may not be necessary.

I suggest that individuals talk to their GP or Specialist to see if they would require a biopsy before treatment.

I hope that clarifies things! ”

Talk to your Health professional if you have concerns and remember they are there to look after your health and have your best interests at heart.
A liver biopsy can give valuable information regarding staging, prognosis, and management of Hepatitis C.
In New Zealand to access treatment for Hepatitis C mostly you will have to have a biopsy,

“It took me years to work up the courage to have one, It was not as bad as I had expected at all.”
A biopsy revels the extent of liver fibrosis which also may determine your priority for treatment in some DHB’s in New Zealand.

Community Pharmacies Testing for Hepatitis C and B

This is my favorite World Hepatitis Day activity from England

“A pilot project developed by The Hepatitis C Trust will see pharmacies in five PCTs across England offering free, on-demand dry blood spot testing for the potentially fatal viruses.

Pharmacists in 19 participating stores have been trained to carry out the tests and give patients lab results. If positive, patients will be referred to their GPs for treatment.

The Hepatitis C Trust hopes the confidential yet accessible community pharmacy setting will persuade hundreds of thousands of potentially undiagnosed hepatitis sufferers in England to come forward for testing”

what a brilliant idea to uncover the hidden burden of hepatitis c in our communities.

Be great to see Community pharmacies offer this service in New Zealand

Hepatitis C: The silent killer among us

Article from Press newspaper Hepatitis C: The silent killer amongst us.

“Hepatitis C’s stigma as a “junkie disease” could be preventing thousands of New Zealanders from getting potentially life-saving treatment.

About 50,000 New Zealanders are infected with hepatitis C, with many infected through unscreened blood transfusions, experimentation with intravenous drugs or by just using a flatmate’s razor.”

How long hepatitis C could survive in syringes ?

A description of the experiments done at Yale university to find out how long hepatitis C could survive in syringes. Also a good explanation of why Hepatitis C is so infectious.

Was sitting in Lab getting my blood tests today  and listening to the blood gurgle out of me and fill the vacuum tube, listening because I never look. thinking how much I hate blood tests and hopefully this might be my last one for a while.

Here is hoping…….

Best of health

www.hcv.org.nz

May 9, 2009

New Zealand District Health Boards and Hepatitis C

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , , , , , — admin @ 6:17 pm

Thanks to the New Zealand District Health Boards

that have already responded to our questions about Hepatitis C in New Zealand.

It has been impressive to see how the DHB’s, who have replied so far are addressing and the treatment and care of people with Hepatitis C.

A common thread seems to be the increase in access to pegylated interferon for all genotypes.

I will post survey results received on World Hepatitis Day May 19 th.

I missed the news but apparently it is no longer mandatory to have a liver biopsy before treatment can be accessed. I will try and confirm this but that is what we were told.

Hepatitis C is a notifiable disease in New Zealand,

The current case definitions for the notification of acute hepatitis C are confusing to say the least,

“Demonstration of documented seroconversion to HCV when the most recent negative specimen was within the last 12 months,

OR

Demonstration of an anti-HCV positive test or HCV RNA test and a clinical illness consistent with acute HCV within the previous 12 months where other causes of acute hepatitis can be excluded

Notifications of acute HCV are known to significantly underestimate the true number of new infections diagnosed and notified each year.

Contributing factors to under diagnosis in New Zealand may include:

  • The frequently asymptomatic nature of acute infection
  • The illegal nature of injecting drug use
  • Insufficient testing of people at high risk of infection
  • Lack of awareness by many people that they have been potentially exposed to the virus through one-off or occasional IV drug use or the receipt of blood or blood products prior to blood donor screening
  • Poor access to health care for some high risk individuals

It is not possible to accurately extrapolate HCV incidence or prevalence rates from notification data.“

source Hepatitis C infection in New Zealand: Estimating the current and future prevalence and impact July 2000

Most GP’s have no idea Hepatitis C is notifiable or at what stage it becomes notifiable so they tend to not do anything about notification,

And looking at the numbers here one can see this is likely the case

hcvratesnznotifiable1

Notifiable disease diseases (hepatitis C ) on the New Zealand Ministry of Health website

http://www.nzpho.org.nz/NotifiableDisease.aspx

Found a article in New Zealand Doctor about Christchurch Hepatitis C Clinic here.

$600,000 for pilot hepatitis C clinic

Liane Topham-Kindley

A community clinic for people with hepatitis C, the first of its kind in the country, is due to open in Christchurch in January.
The Ministry of Health has committed almost $600,000 to the clinic which will operate as a pilot over three years.

http://www.nzdoctor.co.nz/news?article=D0048131-515A-43D9-9CFF-EE0C7A3FD19E

I imagine a lot of money from a lot of additional different sources has been invested in this pilot study on top of that mentioned in this article. $600,000 for duplicating existing Christchurch health services.

It seems the needle exchange program has captured a lot of the public funding for hepatitis C
in New Zealand.

How effective is the needle exchange program, in reducing HCV infection?

Could it be improved, perhaps it is time for an independent audit of New Zealand needle exchange program performance with the aim of improving the service and access.

100% coverage and removal of some of the more stupid polices that make New Zealand Needle Exchanges less effective in slowing the spread HCV in New Zealand.

The Primary Prevention of Hepatitis C among Injecting Drug Users

This recent English report on The Primary Prevention of Hepatitis C among Injecting Drug Users

Review the prevention of hepatitis C and what actions could be taken to reduce its transmission and improve knowledge and awareness, particularly among at-risk groups. The report therefore focuses on HCV prevention among injecting drug users

The evidence suggests that the most effective way of reducing HCV incidence among active IDUs is through a combination of Opiate Substitution Therapy (OST) and the provision of Needle and Syringe Programmes (NSP).

Recommendations around gathering data on HCV regarding epidemiology, testing and treatment referrals. Such information will provide more robust evidence upon which decisions underpinning policy can be made.

Recommendation 1. Local service planners need to review local needle and
syringe services (and be supported in this work) in order to take steps to
increase access and availability to sterile injecting equipment and to increase
the proportion of injectors who receive 100 per cent coverage of sterile
injecting equipment in relation to their injecting frequency.

Recommendation 2. Local services need to provide a comprehensive
intervention so that those offering OST also provide access to sterile injecting
equipment and those providing sterile injecting equipment facilitate entry into
OST.

There are twelve other recommendations all should be adapted in to Hepatitis C policy in New Zealand.

http://drugs.homeoffice.gov.uk/publication-search/acmd/acmdhepcreport2?view=Binary

It would be better for New Zealand to act now before we turn in to the Egypt of the south pacific.

Although Egypt EGYPT: Viral Time Bomb Set to Explode   a public health disaster with the vaccination programs in the 1960’s which helped spread hepatitis C to twenty percent of the adult population the world’s worst rate of infection.

I have often wondered how third world countries will be able to effectively address Hepatitis C.  I think patent’s preventing cheap generic copies of Interferon’s and anti viral s  should be relaxed as was suggested by a recent legal appeal in India.

Otherwise treatment is just unaffordable for the majority of the population of these countries.

Best of Health

www.hcv.org.nz

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