New Zealand and Australian health authorities are tracing 55 New Zealand women who visited a private medical clinic in Australia between 1 January 2006 and 7 December 2009 who may be at risk of having contracted Hepatitis C.
Ministry of Health Deputy Director of Public Health Dr Fran McGrath says Australian authorities identified the link between a cluster of hepatitis C cases and a private medical centre in the State of Victoria, Australia in April and are now investigating how this happened.
There is a police investigation in Victoria and media reports of legal action in Australia being planned.
“The Department of Health in Victoria, has taken responsibility for tracing, directly contacting and confidentially informing all 3,500 women concerned, including the 55 affected women giving a New Zealand address.”
The Department began contacting the New Zealanders yesterday as they worked through the 3500 women being traced. Around 1000 Australian women have been contacted and 746 tested.
Of those tested 44 have been found to have hepatitis C, around half of whom have had their infection linked to the private medical centre.
Because of the difficulties involved in tracing the women, the Ministry of Health will be working more closely with its Victorian counterpart in helping trace the New Zealand women concerned.
New Zealand women who had procedures at the Croydon Day Surgery in Croydon, Victoria from 1 January 2006 to 7 December 2009 can call Healthline in New Zealand and be transferred free of charge to a confidential Australian hepatitis line for further information.
“This is a sensitive and potentially distressing situation and the Ministry of Health here and health authorities in Australia are being careful to protect the privacy and confidentiality of the women involved”, Dr McGrath says.
Specialist staff in District Health Boards in New Zealand are on standby to offer blood testing, follow-up, support and treatment if necessary.
“Based on the results of women tested to date approximately 5% of women treated at the clinic may have contracted Hepatitis C. Based on this information we estimate that up to 3 New Zealand women may test positive.”
Any woman who has received treatment in a Melbourne private clinic in the four years from 2006 to 2009 should contact (New Zealand ) Healthline 0800 611 116 for advice.
Hepatitis C is a blood-borne virus that causes inflammation of the liver and which can have serious complications.
For more information contact Peter Abernethy, Media Relations Manager, 021 366 111
The number of women infected with Hepatitis C after being treated by a Melbourne doctor has grown to 44 and is rising.
Another 32 women have tested positive to the infection after being treated by James Latham Peters, an anaesthetist at a Croydon abortion clinic, the Department of Human Services (DHS) revealed on Monday.
That number is certain to grow and the DHS has urged any women who have had abortions and been treated by Dr Peters at the Croydon Day Surgery to contact them.
The number of women infected with Hepatitis C after being treated by a Melbourne doctor has grown to 44 and is rising.
Another 32 women have tested positive to the infection after being treated by James Latham Peters, an anaesthetist at a Croydon abortion clinic, the Department of Human Services (DHS) revealed on Monday.
That number is certain to grow and the DHS has urged any women who have had abortions and been treated by Dr Peters at the Croydon Day Surgery to contact them.
More than 1100 women treated by Dr Peters since 2008 have been contacted by DHS and told to be tested, with the results of 746 women received showing 32 infection cases, Victoria’s chief health officer Dr John Carnie said.
Dr Carnie and police believe the doctor recklessly and maybe deliberately infected the women by using needles he had contaminated.
“The more cases you find in this instance, it becomes more and more difficult to explain this by any other accidental means,” Dr Carnie told reporters on Monday.
New Zealand World Hepatitis Day, May 19 2010 update
A couple of events for world Hepatitis month here in New Zealand
Hepatitis Free concert in Latimer Square Christchurch May 22 nd 11 am – 4 pm
The Hepatitis C Resource Centre Te Waipounamu in conjunction with World Hepatitis Day proudly present a free concert in Latimer Square Christchurch Saturday May 22 nd 11 am – 4 pm info stalls, Sausage Sizzle,bouncy castle, byo picnic
Lots of Bands Squirm , Dialtones , Mynor Starr ,Anthesiac, Magic Eye, Anthesiac,Papanui High School Jazz combo, ChisnallwoodIntermediate Bands Vivid Distortion, Chain Reaction, Closing Time, 1.5l sprite bottle, DJ Detox Damage.
further details contact Hepatitis C Resource Centre Christchurch phone 3663608 email hcv @xtra.co.nz
Opening of the new Hepatitis C Resource Otago Centre office May 19 2010
A great day out in Christchurch and if you make it to the event watch out for Hepatitis C Resource Centre Dunedin phlebotimist Heath in his band, Heath will be back in Dunedin on 19 May for the opening of the new Hepatitis C Resource Centre office in Dunedin.
further details contact Heath and Allison at Otago Hepatitis C Resource Centre hepcotago @xtra.co.nz
The past month has seen a lead up campaign of one in twelve hepatitis awareness ads played nationally on TV 3
World Hepatitis Day, May 19, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis and treatment.
World Hepatitis Day is led by the World Hepatitis Alliance, which represents 200 patients groups and organizations http://www.worldhepatitisday.org/en/Home.aspx
The Hepatitis Comics
Have a laugh with Lucinda K. Porter ‘s blog The Hepatitis Comics. Lucinda is hepatitis C positive and positively believes in the power of humour.
Medical transmission of Hepatitis C from Australia
VICTORIANS worried about their contact with Dr James Latham Peters over the past four years should contact health authorities - not just patients of the doctor in 2008 and 2009, as first stated last week.
A spokesman for the Department of Health last night confirmed that Dr Peters had worked at Croydon Day Surgery - the clinic where he allegedly infected 12 patients with his own strain of hepatitis C - since 2006.
On Friday, Victoria’s chief health officer, Dr John Carnie, said the infected patients had visited the clinic between June 2008 and December last year, and that patients worried about their contact with him at the Croydon clinic during this period should contact the department.
He said departmental workers were also trying to contact patients they believed to be at risk of contracting the blood-borne virus from him during this 18-month period.
But the department spokesman last night said authorities would also encourage patients who visited Dr Peters at Croydon Day Surgery as far back as 2006 to seek further information from the department if they were worried about the virus.
As of last night, the department had received 830 calls from people with questions about the anaesthetist, who is believed to have been using drugs when he infected patients with his particular strain of the illness.
Last week, Dr Carnie said he referred the matter to police in March because he found it hard to imagine how the transmission of the virus had been accidental.
‘Warehoused : when patients elect to wait for the new drugs’
Warehoused : Thought this was interesting about waiting for new treatments, I think you might have to wait extra long for pharmac to fund a new treatment in New Zealand. So maybe prepare to be in your warehouse with hep c for a long time ?
Hepatitis C Patients May Boost Merck, J&J, Vertex
http://www.businessweek.com
By Michelle Fay Cortez and Naomi Kresge
April 19 (Bloomberg) — At Fred Poordad’s bustling hepatitis C clinic in the heart of Los Angeles, one in every five patients receives no treatment. They are waiting for a wave of new drugs, expected in the next 18 months, that may boost their chance at a cure by as much as 10-fold.
They’re just the first among new therapies anticipated in the next five years as companies seek a single pill to cure the infection. Poordad, chief of hepatology at the Liver Disease and Transplant Center at Cedars-Sinai Medical Center in Los Angeles, doesn’t object when his patients elect to wait for the new drugs, a practice known as “warehousing.”
“The warehousing has been going on for the past year or so,” Poordad said. “I think we’ll see a tremendous increase in the volume of patients that are treated. That’s the most exciting thing in the field for a long time.”
The drugs closest to market, Merck’s boceprevir and telaprevir from Vertex and Johnson & Johnson, are protease inhibitors crafted from the technologies that led to discoveries made in the fight against HIV. The new treatments are being tested as additions to current standard treatments. Both drugs work by blocking the action of the protease enzyme the hepatitis virus needs to replicate, directly stopping it from spreading.
Warehoused better than a wallet biopsy………….
Telaprevir, has had a trial here in NZ recently, with another trial coming soon.
Adding the investigational drug telaprevir to standard treatment for hepatitis C infection cures about half the patients willing to give therapy a second try. That compares to a cure rate of just 14 percent among those who were re-treated with the standard regimen, according to researchers at Duke Clinical Research Institute.
Hepatitis C New Zealand blog January 2010 New Zealand Viral Hepatitis Whakatane 2010
New Zealand Viral Hepatitis 3rd NZ Conference Whakatane 2010
Friday 05 March – Saturday 06 March 2010
War Memorial Complex, Whakatane, New Zealand
Invited Speakers: Professor Mitchell Shiffman, USA
Professor Andrew Lloyd, Australia
Dr Morris Sherman, Canada
Dr James Fung, Hong Kong
Around half the conference will be about hepatitis B and the other half hepatitis C
With topics such as
Relevance of viral load; is it a predictor to HCC? James Fung
Multidisciplinary approach of HCC in NZ John McCall or Adam Bartlet
Therapies available for patients with HCC in NZ Catherine Stedman
State of the Art Lecture
Optimisation of Outcomes with current standard-of-care” (on use of baseline and
on-treatment responses (RVR, EVR) to individualiase therapy, weight-based RBV).
What’s next – direct acting antivirals (DAAs )Mitch Shiffman
HCV in Correctional Facilities
HCV prevention, treatment and follow-up in prison populations Andrew Lloyd
HCV in NZ correctional facilities Frank Weilert
NZ model in an Auckland prison Steve Gerred
Difficult-to-treat patients
State of Art Lecture
“Approaches to non-responders – retreatment, induction dosing IFN,
higher dosing RBV, maintenance therapy – do they work” Mitch Shiffman
Alternative therapies for HCV
Is there alternative therapies for HCV treatment and do they work? TBA; College of natural therapies
Middlemore audit of patients taking alternative therapy Jacinda Ryan
Hepatotoxic therapies Sarah Fitt
Debate: Should there be a national register for chronic HBV & HCV?
You can find out more about the conference at the hepatitis foundation of New Zealand Website here
Our invite must have got lost in the mail and our budget of zero precludes travel. The joys of the peer based NGO.
New Zealand hep c news letter
Got my first email copy of the New Zealand hep c news letter , a joint effort by the Auckland Christchurch and Dunedin Hepatitis C Resources centres.
Well actually I accidentally deleted it so if you want to check it out Hepatitis C resource centre 0800 224372 (0800 22 HEPC)
A viral hepatitis testing pilot project in 19 pharmacies across the country has found a hepatitis B or C positive patient in every 6 tests conducted.
I mentioned this chemist based anonymous testing for hepatitis at English pharmacies a while back; the results of the trial have been interesting
19 pharmacies in 5 PCT areas offered free, on-demand hepatitis B and C dried blood spot tests to clients who had been at risk of contracting viral hepatitis as part of a 3-month pilot project organised by The Hepatitis C Trust. Across the pharmacies a total of 234 tests were conducted, diagnosing 35 people with hepatitis C (15% of tests) and 4 people with hepatitis B (2% of tests). This is a far higher proportion of hepatitis C positive diagnoses than found in GP surgeries, where 4% of tests find positive hepatitis C patients and 2% of tests find hepatitis B patients.
Dev Dalvar from D R Pharmacy in Sandwell PCT commented on the pilot: “Offering hepatitis B and C tests in my pharmacy has been a huge benefit to the local community. The people diagnosed will now be able to access potentially life-saving treatment and many customers are more aware about the viruses and risk factors.
Charles Gore, Chief Executive of The Hepatitis C Trust said: “It is a tragedy that increasing numbers of people with hepatitis C are dying, often because they have been living with the hepatitis B or C undiagnosed for years, even decades. There are at least 100,000 people living with the hepatitis C unawares but only 8,000 people were diagnosed last year. We desperately need a new approach to testing that will find the undiagnosed patients and this pilot study shows pharmacy testing could be just what is needed.
A series of Hepatitis C videos from the Harm reduction works
HIV, hepatitis C and injecting drug use, part 2: The sharing of injecting equipment
Patients with chronic hepatitis C and advanced liver disease who drink three or more cups of coffee per day have a 53% lower risk of liver disease
progression than non-coffee drinkers according to a new study led by Neal Freedman, Ph.D., MPH, from the National Cancer Institute (NCI).
The study found that patients with hepatitis C-related bridging fibrosis or cirrhosis who did not respond to standard disease treatment benefited
from increased coffee intake. An effect on liver disease was not observed in patients who drank black or green tea. Findings of the study appear
in the November issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
Three cups a day and a 53% lower risk of progression that has to make coffee a good option for those with hep c.
The Good news for new treatment options Telaprevir
Good news for People with Genotype one Hepatitis C is the latest results of the new drug telaprevir
Cork, Ireland (October 31, 2009) –Tibotec announced today results of a new study (VX950-C208), which showed that sustained virologic response (SVR)
was achieved in more than 80 percent of treatment-naïve patients with chronic genotype 1 hepatitis C virus (HCV) who took telaprevir, administered either
every 8 hours or every 12 hours, in combination with standard of care. Telaprevir, an investigational STAT-C (Specifically Targeted Antiviral Therapy for hepatitis C),
is being co-developed by Tibotec in collaboration with Vertex Pharmaceuticals. The study was presented today at the 60th Annual Meeting of the
American Association for the Study of Liver Diseases (The Liver Meeting).
In the phase II study, which enrolled 161 treatment-naïve genotype 1 patients, rates of SVR (defined as undetectable HCV RNA at 24 weeks after completion of treatment)
ranged from 81 to 85 percent in patients treated with the every 8 hour telaprevir-based regimen, and 82 to 83 percent in patients treated with the every twelve hour regimen.
Adverse events (AEs) were similar to those observed in other trials with telaprevir and were mainly haematologic (anaemia) and cutaneous (rash and pruritus) in nature.
For the vast majority of patients, these high SVR rates were obtained with only 24 weeks of total treatment (half the duration of current standard of care).
Total duration of treatment was decided using a criteria based on treatment response. Subjects who achieved undetectable HCV RNA at week 4
(rapid virologic response or RVR) and maintained this through week 20, were allowed to stop all treatment at week 24. Only 18% of subjects were required to continue standard treatment up to week 48.
Source: Johnson & Johnson Services
Good news for me
My post treatment 24 week viral load came back undetectable
” I wish you good health and a sharp pen. Raising awareness of hepatitis C is an uphill struggle… but day by day, one step at a time, it is happening. It is interesting to consider that, if we could get over the brain fog ; D, there are enough of us in the world with this condition, to form our own group/religion/club… if 180 million sufferers were all to shout on the same day, at the same time… mmm … I think I’ll put the kettle on. ”
Thanks Tracy great message. Just off to have a cup of tea myself, maybe a coffee as it seems that may be better for me.
Interesting to discover so many trials underway in New Zealand and these are just the current ones. I guess if you want to get on a drug trial you are chosen as opposed to applying in most cases, but its all ways worth asking your medical provider about them.
You can read more detail at this informative site
www.ClinicalTrials.gov
ClinicalTrials.gov United States National Institutes of Health offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions. A clinical trial (also clinical research) is a research study in human volunteers to answer specific health questions. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people or populations in natural settings.
When drug trials go Bad
Whenever I think of drug trials I think of guinea pigs and the tragic British drug trials of March 2006, A case of guinea pig beware I guess.
“It was the first time the drug TBN1412, designed to treat conditions such as rheumatoid arthritis and leukaemia, had been tested on humans.
Within hours of taking it on Monday, the six young volunteers had to be admitted to intensive care.
Ms Marshall, 35, whose boyfriend is critically ill, said the normally healthy 28-year-old’s face was so puffed, he “looks like the Elephant Man”.
She said he was completely lifeless, unable even to move an eyelid.
“They just keep saying he’s very, very sick and we are doing all we can,” she added. “
Such clinical trials were essential for the development of new and better treatments
The Medical Research Council said that while it was “an unfortunate and extremely rare event”, such clinical trials were essential for the development of new and better treatments.”
Savings can be generated in 2008/09 and 2009/10 by delaying contracting for services from within the draft Hepatitis C plan that have not yet been agreed and provided.
We don’t get?
These are likely to include information and education services and DHB/Primary Care treatment services.
We get ?
A clinic in Christchurch for a three year proof of concept pilot programme to trial the provision of a Community Clinic
evaluation of the Christchurch clinic pilot
Haemophilia Foundation New Zealand - contracts to discharge obligations made under the Government’s Hepatitis C no-fault decision.
I think this is entirely unacceptable for the magnitude of the epidemic we are dealing with. Somebody does not get it.
We get a Community Clinic in Christchurch that duplicates existing services in a community, that already has two treatment providers ?
We don’t get information and education services and DHB/Primary Care treatment services for the rest of the country.
Which option benefits the most individuals and communities ?
What is going to make the most difference to the Hepatitis C epidemic in New Zealand ?
Christchurch Community Hepatitis C Clinic who is it ?
Needle Exchange New Zealand, the Hepatitis C Resource Centre and Rodger Wright Needle Exchange Programme. A smoggy triangle of organisation’s based in Christchurch came up with the idea of a clinic for Christchurch.
The clinic will be governed through the Drug Injecting Services in Canterbury Trust which operates as the Rodger Wright Needle Exchange.
Christchurch PHOs, Partnership Health , Canterbury Community and Ministry of Health have provided financial assistance to support the clinic .
If the Christchurch pilot proves successful, it is hoped similar clinics will be rolled out in other centres.
Christchurch already had a good level of hepatitis C treatment already according to the Christchurch DHBread more here
Where is the famous hepatitis C Plan ?
We have seen the mess that exiting servcies are in and it now seems a solution has been postponed. Yet we can’t even see this mythical Hepatitis C plan to see what has been cut .
INVEST IN HEPATITIS C TREATMENT
It saves money you , It costs more to not treat, not addressing the problem is ensuring the future costs grow with the epidemic.
Health Economist, Ian Sheerin, from the National Addiction Centre at the Christchurch School of Medicine and Health Sciences says the lack of strategic screening, management and treatment for IDUs with Hepatitis C will cost the country dearly in coming years. He says there will be a multiplier effect in terms of increased health costs through extra GP visits, diagnostic tests, hospital outpatient follow-up, and inpatient admissions for liver cirrhosis and liver transplants.
“The figures should be of concern to health planners. There has been little official recognition of the implications of these escalating costs which will run into many millions of dollars in future,” says Ian Sheerin. ” My research predicts that there will be a cost of between $166 and $400 million over the next 30 years because of a lack of adequate treatment of Hepatitis C at present.”
Ian Sheerin says there is also the attitude amongst some members of the public that drug users don’t deserve any treatment at all. He says this is short-term thinking that will rebound on the taxpayer as more intravenous drug users end up in hospital with complications as a result of advanced Hepatitis C infection. With Hepatitis C, early intervention is arguably the most rational economic course to follow, resulting in fewer cases of severe liver disease while benefiting the patient at the same time.
Ian Sheerin National Addiction Centre Christchurch School of Medicine and Health Sciences University of Otago
Instead of making savings. These delays / savings in the 2009 budget are generating greater future costs.
I’ve been studying this Treatment flow chart from a New Zealand District Health board.
I’m impressed by the level of detail and it does explain treatment and testing quite well.
Note Under perform liver biopsy we have the standard
Metavir classification for staging of hepatitis C liver disease (Biopsy) But also some treatment decision information
Fibrosis Scale and Grading
Stage 0 No Fibrosis - No scarring NO TREATMENT RECOMMENDED REPORT BIOPSY IN 4 TO 5 YEARS
Stage 1 Portal fibrosis - Minimal scarring NO TREATMENT RECOMMENDED REPORT BIOPSY IN 4 TO 5 YEARS
Stage 2 Extra portal fibrosis - Scarring has occurred and extends outside the areas in the liver
that contains blood vessels CONSIDER TREATMENT
Stage 3 Bridging fibrosis is spreading and connecting to other areas that contain fibrosis TREAT
Stage 4 Cirrhosis or advanced scarring of the liver
I find it quite incredible that people won’t be treated until they reach advanced liver
Disease.From experience I know you can feel crap and have a really poor quality of life
with hepatitis C, before any fibrosis forms in your liver and the early stages are when
Hepatitis C is most likely to respond to treatment.
Suggesting a person waits until damage is more advanced seems questionable….
Apparently not having a liver biopsy would be is a better option as you “Consider treatment”
Its’ like playing Russian roulette with someone else’s health telling them to wait and see.
I haven’t got a problem if it’s all explained to the patient and they make a informed decision, But patients are usually at a disadvantage they lack information to make that decision and trust the health professional they know best….
Wonder how many people are waiting for their liver disease to progress till it becomes “treatable”
My favourite quote of the month has to be
General (r) Tasawwar Hussain while speaking to audience, however, presented a new concept
saying that the occurrence of hepatitis B & C has increased with the increase in number
of health care facilities across Pakistan. “It convinced me to believe that unnecessary or
unsafe pricking at the health care facilities is one of the major causes of spread of
hepatitis in Pakistan and it should be discouraged religiously by medical professionals.”
So beware at all times of “ unnecessary or unsafe pricking at the healthcare facilities “
Meanwhile in Ireland :Irish Hep C health service faces a struggle
“the creation of a national register for people with hepatitis C, as a result of the lack
of concrete data on the prevalence of the virus amongst the Irish population.
The strategy also states all laboratory requests for hepatitis C serology must
contain full patient identifiers and full clinician details, as many notifications
continue to be incomplete even though it was made a notifiable disease in 2004.
Other recommendations include screening for hepatitis C and other blood-borne
diseases to those who attend services such as needle exchange programmes,
the establishment of an expert group to provide governance on clinical issues,
the development of interventions to delay and prevent transition from smoking
to injecting, the provision of supports to attend treatment, and the development
of peer support networks.
The most important requirement for drug clinics treating hepatitis C patients
is to have a clinical nurse specialist to coordinate and help administer care,
according to Dr Troy. “
New Zealand Hep C plan
Sounds good still waiting for the New Zealand Hep C plan I asked Hon Tony Ryall
our minister of health for a copy last week, wonder how long will have to wait to
see a copy of that……
Not as long as you going to have to wait for treatment if you live in ? which New Zealand Distinct Health Board
Hepatitis C Treatment New Zealand District Health Boards
Ive been busy chasing District Health Boards to reply to our Hepatitis C treatment questions, Only three of the twenty one district health boards are yet to produce a reply and only one has ignored the request.
Treatment Outcomes and Terminology
There has been a bit of a discussion on the forums lately about monitoring treatment and the terminology
• Rapid Viral Response: viral clearance at week four of treatment.
• Early Viral Response(complete): viral clearance at week 12 of treatment.
• Early Viral Response(partial): Significant drop in viral load at week 12 of treatment, ie. two log drop in viral load, eg. from 60,000 down to 600.
• Non-Response: no significant drop in viral load after twelve weeks of treatment. This means you probably won’t be cured.
• End-of-Treatment Response: whether or not the virus is detectable in your blood at the end of treatment (either six months or twelve months). This is good but it
doesn’t mean you are cured.
• Sustained Viral Response: viral clearance as proved by a negative PCR result six months or more after treatment finishes. This is the result that people hope
for and is what doctors refer to when someone is successfully cured
First up Teenager Jazzy was born with hepatitis C. This is her video diary about living with the condition
Produced and directed by Jazzy De Lisser “I will try treatment again”
A series of informative videos from Nicole Cutler describes the various methods by which Hepatitis C is transmitted. www.hepatitis-central.com
Transmission
I have been watching MusicKey ’s hepatitis C treatment Journey for a while now , GO MUSIC KEY beat the virus
Another hepatitis C treatment video blog here
lots of encouragement to anyone on treatment and those contemplating it
“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.
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?
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?
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?
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?
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?
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.
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
