Hepatitis C New Zealand

December 14, 2009

Hepatitis C New Zealand laboratory notification

Strategic Directions for Hepatitis C improving access to and uptake of hepatitis C treatment services.

One of the key points of this unreleased document, (Rumour has it will be never released as it involves the New Zealand Ministry of Health  acknowledging they have a major problem and actually doing something about it , i.e. spending money.)

Key action area 4 Improving knowledge about HCV prevalence in the New Zealand population and within sub groups.

HCV is a notifiable disease in New Zealand, but is really notified.

In Australia they operate a national registry for HCV the register gathers notifications from care providers and reference laboratories. Reference laboratory notifications in Australia make up 90% of all notifications.

It seems logical then to introduce  a laboratory notification system here in New Zealand to give accurate information on the number of people of people in New Zealand with HCV similar to what already occurs for HIV and aids notifications.

It seem a fundamental first step to dealing with any contagious disease is to effectively measure it’s prevalence we hope 2010 is the year the New Zealand  Ministry of health make this a priority.

Small chance of being diagnosed and treated for hepatitis C in New Zealand

I had an interesting conversation the other day.  Bob was saying how great he felt after completing Hepatitis C Treatment a couple of years back. We agreed the treatment sucked but the change in your health after completing successful treatment can be miraculous, he claimed to feel like he was 16 again, although I don’t feel that good the energy levels were back and I do feel healthy.

Bob claimed he could get up in the early morning climb a mountain shoot a deer, gut it out and climb back down with a dead deer on his back and then go and work all day. Me I’m just happy not to be constantly exhausted all the time.

Small chance of being diagnosed and treated for hepatitis C in New Zealand. Based on the fact that nationally approximately 300 people are treated per year and 50,000 are estimated to have hepatitis C. Made me feel lucky and thankful.

It always amazes just how wide spread people with Hepatitis C are and how little they talk about it because of the perceived stigma of the disease.

Some don’t seek hepatitis C treatment

NEW YORK, Nov. 10 (UPI) — U.S. researchers say patients with more difficult to treat forms of hepatitis C are half as likely to get treatment as those with easier to treat forms.

Dr. Thomas McGinn of Mount Sinai School of Medicine said the researchers also found marital status also affected whether patients chose treatment for hepatitis C.

“Overall, in general only about 30 percent of hepatitis C patients choose to initiate treatment for the disease,” the senior author said in a statement. “It’s a huge problem that needs to be addressed. This study confirms that genotype is a major barrier to treatment. We hope these findings will lead to changes in how physicians approach patient care in a way that increases the rate of treatment initiation.”

In this study, of the 168 treatment-eligible patients, 41 began treatment and 127 did not — or 24 percent sought treatment. Patients with genotypes 1 and 4 of the disease, which are less responsive to treatment, were less likely to initiate treatment, as were unmarried patients and patients with multiple diseases, or medical comorbidities.

The findings are published in the of Journal of Health Care for the Poor and Underserved.

http://www.upi.com/Health_News/2009/11/ … 257886770/

Hep c new treatment tested New Zealand

A recent news release about some successful hepatitis C   New Zealand Drug trial’s,  Interesting about US not allowing drug  trial within US, but ok for New Zealand and Australia etc

Hep c new treatment tested Wellington, Nov 6 NZPA – Researchers are claiming success in a New Zealand clinical trial of antiviral drugs used against the hepatitis C virus (HCV).

A combination of two experimental anti virals led to dramatic reductions in viral loads during the 13-day pilot trial, according to Edward Gane, of Auckland Clinical Studies.

Hepatitis C is a virus carried in the blood that can damage the liver, leading to cirrhosis (scarring), failure and cancer, and it has infected more than 30,000 New Zealanders.

The Food and Drug Administration (FDA) in the United States does not permit the illness to be treated without interferon- because of concerns such treatments could provoke resistance to drugs that might otherwise remain effective.

The drugs’ lead developer, Roche, said in a statement that phase two clinical trials would start early next year, though the studies must continue to be conducted outside the US because of the FDA policy on interferon.

Health Cheque

Been reading Health Cheque the truth we should all know about New Zealand’s public health system. A new book Gareth Morgan and Geoff Simmons

A great read about the New Zealand Health system, dissecting the subject well, what gets funded who gets treated; it’s well written and balanced in its approach.  Haven’t finished book yet but it is surprisingly readable, and insightful so far

Health Cheque link

NZ Needle exchange success

Thursday, 19 November, 2009 – 14:40 scoop link

Recent data has confirmed that New Zealand’s Needle Exchange Programme is one of the most successful in the world, but we could do even better, says Needle Exchange New Zealand National “Manager Charles Henderson.

He said, however, that a reduction in hepatitis C levels was the most pleasing result of all.

“Our 2004 study revealed that nearly three out of four New Zealand injecting drug users had been exposed to the hepatitis C virus. This year’s study indicates a significant drop in this statistic to around half.

Hepatitis C is a virus that can cause liver disease, leading to years of ill health and possibly even death. It can only be caught via the exchange of blood from an infected person. It is a significant risk for those drug users who share needles or other injecting paraphernalia.

The latest Household Drug Survey indicates 2 percent of New Zealanders inject or have injected drugs at some point in their lives, many of whom do so only occasionally or recreationally. This means 85,000 people are potentially susceptible to blood-borne viruses from drug use.” Charles Henderson

I   think needle exchanges are a good place to engage with active drug users with hepatitis C.  I think they are a key public health initiative New Zealand can be proud off. Lots of potential for preventative health savings in getting the needle exchange program working better and decreasing future spread of hepatitis C.

It is important to realise that the majority of people with hepatitis c don’t attend needle exchanges any more , Charles figures seem to suggest a 25% decrease in the numbers of people with hepatitis C attending  the needle exchange.

“The largest undiagnosed pool of people with HCV are likely to be those aged 40 – 60 years old, who were infected 25 – 40 years ago, who at that time occasionally (or even once) injected illicit drugs , but went on to lead ‘conventional lives’.  (Strategic Directions for Hepatitis C : Improving access to and uptake of hepatitis C treatment services.)

It seems that targeting hepatitis C education funding and programs to needle exchange programs misses the largest group of people with hepatitis C.   The needle exchange is a fantastic cost effective prevention and education program targeting active drug users not all people with Hepatitis c are active drug users.  Associating drug use and hepatitis C just builds and reinforces the stigma associated with Hepatitis C.

Jim Anderton MP made a great speech when opening the Christchurch needle exchange new location.

Anderton: Opening the new Rodger Wright Centre
Friday, 20 November 2009, 2:56 pm
Press Release: Progressive Party

“As a politician, I know that to make a difference to peoples’ lives, more often than not, means going the extra mile. I thank you for your commitment.

I wish we didn’t need this programme. I wish we didn’t have drug use causing the harm it does, wrecking the lives of many people, and wrecking many communities. But it does happen. It will keep happening.

And if we care about vulnerable victims then our responsibility is to reduce the harm to them as much as we can. The needle exchange programme does just that and I continue to support it for that reason.”

scoop here

Injecting, Infection, Illness: Abjection and Hepatitis C Stigma

Magdalena Harris

While Social Research has documented the prevalence and ill effects of Hepatitis C related stigma,

Magdalena discuses ways in which this stigmas is constituted

Three components central to hepatitis C stigma

1. illicit injecting

2. infectiousness and

3. societal aversion to chronic illness

Magdalena is a peer a great writer and world expert on Hepatitis C.  I always enjoy reading and learning from what she has to say, this contains some déjà vu moments where she has managed to capture the essence of many people’s experiences with Hepatitis C. Well worth a read.

Injecting, Infection, Illness: Abjection and Hepatitis C Stigma

Get tested campaign

Get tested campaign from UK  Words of wisdom from Topper Headon and others about getting treated  Get tested get treated now.

Get Tested! from Ross Aitken on Vimeo.

Have a great Holiday season

Best of health

www.hcv.org.nz

May 25, 2009

Increasing Access to Hepatitis C Treatment in New Zealand

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

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