Hepatitis C New Zealand

August 22, 2010

Hepatitis C Fear and Loathing, Biopsy vs. Fibro scan in NZ

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , — admin @ 6:13 pm

Fear and Loathing, Biopsy vs. Fibro scan in NZ

Ultrasound replaces painful liver biopsy surgery for hepatitis C patents in Auckland and Waikato

Painful biopsies have been replaced by an ultrasound technique the Fibroscan (a $200,000 machine) which provides a painless, non-invasive alternative to a needle biopsy by measuring the liver with ultrasound waves and evaluating progression of the disease.

“Obtaining liver tissue by a needle biopsy can be a very painful procedure resulting in bleeding, perforation of other organs, even hospital admission and, rarely, death,” Dr Weilert said.

“This has previously been the only option to assess the liver but the Fibroscan allows us to measure liver stiffness without invasive action.

“It will also allow us to map progress of liver disease better.”

The Fibroscan works through a probe held against the patients’ abdomen.

“The Fibroscan generates a pulse which sends waves through the liver, measuring its stiffness. The degree of stiffness in the liver indicates the amount of disease in the liver – so the greater the stiffness, the more disease there is”, adds Professor Gane.

“Because the Fibroscan procedure is so quick and easy we are able to see more patients in a shorter amount of time and patients no longer need to wait for months to start their antiviral therapy

The procedure takes about 15 minutes. There are currently machines in Auckland and Waikato

See below for Deliverable Three Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand:

http://www.waikatodhb.govt.nz/news/pageid/2145843080
http://www.stuff.co.nz/waikato-times/news/1402330

Associate Professor Ed Gane Champion for HCV for the Ministry of Health.

Associate Professor Gane this year was appointed as Champion for HCV for the Ministry of Health.

In September 2005 a commitment was made by the government, to resolve the longstanding concerns of those infected with hepatitis C through the blood supply. Within this commitment a variety of measures were promised, including provision of an enhanced treatment package. Additional funding was sought and secured for this treatment package and a Hepatitis C Treatment Advisory group, comprising of clinicians, DHB managers and community representatives and chaired by Ed Gane was established to advise the Ministry of Health.

The terms of reference of the Hepatitis C Treatment Advisory Group were to develop a costed and prioritised Implementation Plan, supported by district health boards (DHBs) and the Ministry of Health. This group first met on 17 April 2007. During 2008, they conducted a comprehensive Stocktake of current HCV treatment services provided at each of the 21 DHBs. Following analysis of these results and other information, the committee identified barriers to accessing this treatment and geographical gaps in service provision. They identified priority interventions to improve services and patient outcomes throughout NZ and developed a costed and prioritised implementation plan for improving the access to and uptake of Hepatitis C treatment in New Zealand. The subsequent Health Report and the Hepatitis C Plan was submitted to Hon. Tony Ryall by HCTAG in January 2009.

On 28 July 2009, the Minister approved the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services” and signed off the funding allocation to address the key action areas within the document. These four key action areas, identified within Strategic Directions for Hepatitis C, are: (i) improving HCV treatment services;(ii) improving knowledge of HCV among primary health care providers; (iii) increasing the percentage of all people with HCV who have had the disease diagnosed; (iv) improving the knowledge of HCV prevalence in the New Zealand population and within subgroups.

Plans for primary care, including the new e-learning tool for GPs and Practice Nurses, designed to improve knowledge and encourage opportunistic screening for HCV.

Four Million Dollars Missing from New Zealand Hepatitis C Program

“A major component of the $30 million package announced in December last year is an additional $5 million per year to be invested to improve access to, and uptake of, hepatitis C treatment services. An advisory group has been established to assist the Ministry of Health and District Health boards improve hepatitis C treatment services to all people with hepatitis C, who are entitled to publicly funded health services.”
The ministry have now budgeted one million dollars for these service improvements wonder where the other four million promised went ?

So thirty million to pay for the New Zealand Ministry of health’s professionally incompetent advice and poor performance in protecting the blood supply.

Just one million of a promised five million to improve the situation and actually treat people

Four million dollars just disappearing I get the feeling this is another colossal ministry cost cutting mistake in the making how expensive is this poor health policy going to be in the long term ? time will tell.

Note : To get our (www.hcv.org.nz) copy of the Strategic Directions document we had to write many  Official Information act requests. The Ministry of Health who subsequently lied about our requests to the ombudsman (and were stupid enough to get caught lying) had withheld it for over a year. Now where do you think the Ministry tell people to go to get a copy of the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services”  Well here to  peer based organisation that has no funding www.hcv.org.nz we are hosting Strategic Directions for Hepatitis C document and the only place it’s available, their key document for a million dollar tender W.T.F.

What the ministry want to buy for one million dollars to improve access to and uptake of hepatitis C treatment services

The Ministry is seeking a Provider to deliver the following services for individuals with Hepatitis C:

• appropriate referral from primary care to secondary care via use of a standardised tool;
• provision of integrated care for those diagnosed but untreated or discharged following treatment via use of a shared care clinical tool / protocol;
• equitable access to fibro scanning for diagnosis;
• improved information resources for specific ‘at risk’ population groups; and
• improved detection, access and treatment service delivery models.

The following services are being purchased:

Deliverable One
Develop, consult and disseminate nationally into primary care a standardised referral tool / form from primary to specialist care.
Deliverable Two
Develop, consult and disseminate nationally across providers, a shared care clinical tool / protocol, for the provision of integrated care / management for:
Deliverable Three
Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand including:
Deliverable Four
Develop, consult and disseminate nationally education / information resources for specific sub-population ‘risk’ groups including:

Development of a plan for targeted testing will enable implementation of more effective detection and treatment of at risk groups.
Deliverable Five
Research and provide a feasibility report for a potential three-year programme to promote
the targeted testing of specific ‘at risk’ groups to improve early HCV diagnosis rates and
treatment options for these individuals.
Deliverable Six
Undertake research and development of innovative HCV service delivery model(s) for New Zealand:

(If you want a copy of full tender document you have to go to NZ government GETS site and register )

So if you want a slice of the pie get your applications in It looks like a bunch of stakeholders have tried to carve up the funding pie in to neat little segments only time will tell how effective this will be.

Epidemiological ongoing measurement of the spread of Hepatitis C actually gets a special mention in Strategic directions document but seems to have been completely ignored in the proposal for services. I just wonder where the evidence base for this spending is coming from if we don’t accurately count the epidemic on a ongoing basis?

I would like to have seen money spent on measuring the epidemic more accurately, although as there seems to be an emphasis on meshing the diagnosis / treatment and care of hepatitis C in to a new national GP information system, may be this will also count the spread of the epidemic ?

Looks like we are going to get more community clinics (Deliverable Six) because we need to duplicate treatment services, New Zealand being awash in spare health funding we can afford this ? Most of the country has no access to support services. Wellington Waikato and Invercargill no resources no support services with rural NZ getting the big nothing.This inequality of access to support needs to be addressed on a national basis rather a than a few regions.

We are farming the newly infected from ineffective  needle exchange programs that grow the epidemic , on to community clinics at needle exchanges delivering treatment, a win win situation for needle exchanges as far as capturing  health resources.

This development of a duplicate service to serve the needs of IDU (intravenous drug users) would be better addressed by educating health professionals on how to best to care for and not stigmatize IDU using existing resources  rather than developing a expensive  duplication of resources.

Well the next six months should reveal the shape of hepatitis C improvements so I guess that is progress and I should be a bit more positive about it. Fingers crossed something good happens.

Stop people dying needlessly

My favourite way of testing and diagnosing the majority of individuals who are no longer if ever active drug users would be the English system of pharmacy testing which has proved much more successful that GP based testing.
Last year 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. 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.

Charles Gore, Chief Executive of The Hepatitis C Trust said: “It is a tragedy that increasing numbers of people with hepatitis B and C are dying, often from particularly unpleasant liver cancer which these viruses can cause. It is a tragedy because they have generally been living with the virus for years and could have been given treatment at any point, if only they had been diagnosed. So we desperately need new approaches to testing that will find the undiagnosed patients and this pilot study shows pharmacy testing could be just what is needed.”

“If the pharmacy testing pilot is taken as a model and rolled out by PCTs and pharmacies nationally, we can stop people dying needlessly.”

The Isle of Wight continues to offer these tests after the end of the pilot scheme and has extended it to include added HIV and syphilis tests from the same sample as the viral hepatitis screen. When asked, Gary Warner from Regent Pharmacy on the Island said:

“The results speak for themselves - pharmacies see a different cohort of people to those who see their GP and therefore we can access and diagnose people who otherwise would not have been tested. As an example, the patient that was screened as HIV positive was not someone who would have accessed the test in any other way.”

http://www.medicalnewstoday.com/articles/198364.php

press video here

http://www.youtube.com/watch?v=iG49NTOvOEU

best of health

www.hcv.org.nz

July 23, 2010

100% Pure New Zealand Hepatitis C

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , — admin @ 4:24 am

100% Pure New Zealand Hepatitis C

Who do I have to tell if I have Hepatitis C In New Zealand?

Hepatitis C and Disclosure

Someone asked about Hepatitis C and disclosure

With some help from the Hepatitis C resources Centre Dunedin and the New Zealand

Ministry of Health the definitive reply seems to be.

DISCLOSURE
A person with hepatitis C is not legally required to disclose his/her positive

status unless he/she is,
*A member of, or applying to join, the New Zealand defense force.
*A healthcare worker undertaking exposure-prone procedures.
*Donating blood.

Page 19 of the little yellow book of Hep C Facts,:

If you would like a copy of   the little yellow book of Hep C Facts ring

Hepatitis C Helpline New Zealand 0800 224372 (0800 22 HEPC) or email  the Otago

Hepatitis C Resource Centre hepcotago @xtra.co.nz

Hep C Concert Christchurch

Thank you to Roger Grauwmeijer Rokpx.com Roger@RokPx.com for the images from the day May 22 concert in thepark

chch11

chch82

Dunedin opened it’s new Hepatitis C resource centre

photos were taken speeches were made.

hepcopen2

An article about the opening and the centre’s worker Heath Te Au appeared in the

Otago Daily Times,

” Fresh chance inspires hepatitis C educator

Having a ruptured appendix in the 1990s may have helped save Heath Te Au’s life.

Blood tests taken at the time of this medical emergency showed that he had hepatitis C, most likely the result of sharing needles and drug equipment during a time when he was an intravenous drug user.

After his appendix removal a doctor asked him to think about what he was doing to himself.

Mr Te Au (40) said it was a wake-up call, something which led him to change his life.

He underwent treatment in 1999 and 2000 and is now clear of the blood-borne virus which had been caught early enough not to cause major liver damage.

Now, he uses his experience to help educate others in his role as manager and one of two educators at Otago’s Hepatitis C Resource Centre. ”

Where are the Hepatitis C Resources for Wellington ?

A very large proportion of the population have no access to hepatitis C resources

its’ dysfunctional and emphasis the New Zealand’s Ministry of Health’s complete

failure to address the needs of those affected and infected by the Hepatitis C

epidemic.

The New Zealand Ministry of health attempts to contact the victims of Croydon Day Clinic

Hep C tracking hampered by privacy issues

Health authorities have tested more than half the women in New Zealand potentially exposed to the hepatitis C virus in a Melbourne abortion clinic, but are being hampered by confidentiality rules which mean they cannot leave phone messages.

Fifty-six New Zealand women have called the Ministry of Health’s Healthline, concerned they had contracted the virus after James Latham Paters, an anaesthetist at Melbourne’s Croydon Day Surgery Clinic was now being investigated by police and medical authorities. More than 20 of his patients tested positive to a strain of hepatitis C identical to his own.

“The Australian Victorian health authorities have contacted 33 New Zealanders and the bulk of those have been tested,” said the ministry’s director of public health, Fran McGrath.

The New Zealand test result figures would be released as part of the Australian report once the contacting and testing process was completed. The ministry expected to have a further update in September.

Dr McGrath said contacting the women was a slow process because confidentiality requirements meant callers could not leave messages and had to repeatedly ring back.

“Even contacting one individual can take several calls followed by a registered letter, all of which can take a considerable period of time.”

http://www.stuff.co.nz/national/health/3918567/Hep-C-tracking-hampered-by-privacy-issues

Hepatitis C Resource Centre Otago Stakeholders Meeting June 16

Hep C Seminar Dunedin

Insights offered on hepatitis C, services

“Recent concern about the risk of hepatitis C to women who may have been treated at a private medical clinic in Melbourne highlights the need for increased awareness about the illness, clinical nurse specialist Margaret Fraser says.

Ms Fraser, who is the chairwoman of the reference group for Otago’s Hepatitis C Resource Centre, said there was still widespread ignorance about the condition.

http://www.odt.co.nz/news/dunedin/110725/insights-offered-hepatitis-c-services

After sorting out my family commitments I arrived late at 9.20 so missed the

Opening / powhiri ,  Heath Te Au , Hepatitis C Resource Centre Otago who works as

a phlebotomist and the needle exchange and Margaret Fraser the hepatitis c nurse

from Dunedin Hospital speaking about  Epidemiology and treatment of Hepatitis C

apologies that I missed them speaking.

Dr Janet Downs from the free doctor’s clinic at DIVO the Dunedin needle exchange

talked about  Hepatitis C in the community. She spoke eloquently about her work

at the needle exchange, if you live in Dunedin / Otago and want to see her at the

needle exchange free clinic for IDU Intravenous Drug Users ring the needle

exchange and make an appointment

Dr Michael Schultz, Hepatitis C and what happens if you decide against treatment

was the next speaker.

Key points  “everybody should be treated the earlier the better”

The younger you are when you begin treatment the better chance of a successful

outcome

There were some unique and disturbing aspects to the policy ?  of the Southern

District Heath Board

1, people are not able to get a second course of treatment if the first course

fails to successfully clear the hepatitis c virus.   One strike and you’re out

this just seems to be harsh when retreatment is an option in other DHB’s.

2, You have to have a biopsy in the Southern region ( Dr Schultz couldn’t

understand why anyone would complain about a biopsy as they obviously didn’t have

a problem with needles?)

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.
Interesting sounds like you may not have to have a biopsy in other DHB’s.

If a liver biopsy is a barrier to accessing treatment for some people (I think it

is) we would be better to remove it in some cases ?

Merrilee Williams RN, Otago hepatitis C nurse spoke about treating Hepatitis C

next she was knowledgeable and gave a informative presentation.

Michelle MacDonald, Psychiatric Liaison spoke on treating people with Hepatitis

C
and the neuro psychiatric effects of treatment

Depression
Fatigue
Irritability
Insomnia and sleep disturbances

She explained that preexisting mental health issues can and need to be treated

before treatment

Once these conditions are being treated they do not preclude someone from

successfully undertaking treatment.

Bill Jang, Christchurch Hepatitis C Resource Centre Te Waipounamu arrived by

helicopter (well maybe not, but he made a very brief appearance and then left) ,

he made the interesting point that the recent international 1 in 12 hepatitis

campaign was  actually one in forty New Zealanders have hepatitis B or C.

He has begun educating rest homes on Hepatitis C care.

Shame the needle exchange DIVO wasn’t there to advocate for their clients but

again they to seem to be uninterested in their client’s access to care or issues

surrounding Hepatitis C. Not surprising when the local needle exchange is now

entirely governed  and run from Christchurch as a skeleton service.

Wonder how that works with the Ottawa charter on public health. Best just ignore

best practice for public health and instead have our poorly performing health

services controlled from Christchurch.

The good news is there has been an increase in the number of people being treated

in Otago from 24 to 40. I imagine this is the people with genotype three who are

finally getting treatment after Pharmac changed the funding for treatment for

their genotype finally making it accessible.

If we do the calculation that 1% of Otago population has hep c a figure of 1800

people and the Otago/ Southern ? District Heath board treat 40 per year, we can

calculate that in just 45 years everyone would be diagnosed and treated.

Maybe Bill Jang is right about rest homes, assuming the undiagnosed infected live

that long.

It was a good opportunity to see Hepatitis C discussed in the community in such a

positive way a great morning well done to the organisers.

Their were lots of info  / pamphlets available and I picked up a glossy A4 brochure from Roche aimed at raising awareness amongst NZ General Practice Doctors which has to be a good thing.

You and Pegasys Together we can cure hepatitis C Identify and refer patients today.

gptogethercover

Roche pamphlet targeting GP’s.

With 75 % of hepatitis C patients undiagnosed it seems a timely resource

Each New Zealand GP practice on average would have 15 patients.  Most undiagnosed

and untreated.

txtrochegp

North Island Hepatitis C Resource Centre (Te Ika a Maui)

I just found this website for the North Island Hepatitis c Resouce Centre I’m

guessing it’s the replacement for the old site that seems to have disappeared the

Hepatitis C Resource Centre (Te Ika a Maui)   http://www.hepcresources.org.nz/

put on your sunglasses it’s bright with all those virus floating round.

pegypen

Best of Health

www.hcv.org.nz

June 2, 2010

New Zealand Hepatitis C Croydon Day Surgery

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , — admin @ 10:51 am

NZ Ministry of Health Press Release

2 June 2010

55 Women at Risk of Hep C being Traced

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

Further information can be found at the Victoria Department of Health website http://www.health.vic.gov.au/chiefhealthofficer/alerts/

Press release ends

Hepatitis C cases linked to doctor grows


AAP

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.

http://news.smh.com.au/breaking-news-national/hepatitis-c-cases-linked-to-doctor-grows-20100531-wpuu.html

best of health

www.hcv.org.nz

December 14, 2009

Hepatitis C New Zealand laboratory notification

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , — admin @ 3:39 am

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

August 8, 2009

Strategic Directions for Hepatitis C, New Zealand report HCTAG

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , — admin @ 4:45 pm

Strategic Directions for Hepatitis C,

improving access to and uptake of hepatitis C treatment services.

HCTAG Hepatitis C Treatment Advisory Group , NZ ministry of health

Thanks to NZ minister of health Hon Tony Ryall for releasing this draft copy

A few points that I found interesting the context for HCV Planning

The 50,000 figure with 1300 new infections per year, and we are treating around 600

“unless annual numbers of HCV positive New Zealanders receiving anti viral therapy  were to increase by % 300”

This would put the treatment numbers ahead of the new infections. At the moment we are going backwards every year with less treated than catching hepatitis C.

The current numbers are a joke, a token effort from The Ministry of health they are doing something just nowhere near enough to make an impact on the epidemic.

The pool of infected is growing every year, I could wear myself saying this, but fortunately this report lays it all out, in a much more logical manner then me.

Will anything change  ? NO .

The Ministry of health  are growing a massive public health disaster and there poor quality decision making and public health policy is growing the epidemic and future heath costs

Other recommendations

Key action areas increasing diagnosis

Key action area 3: Increasing the percentage of all people with HCV who have had the disease diagnosed

Key facts

An estimated 75 percent of the New Zealand population with HCV are unaware that they have the disease.

The major barriers to treatment in New Zealand with HCV infection are that people are unaware of their infection, or that the diagnosis is delayed until the liver disease is advanced, by, which time treatment is less effective. Because most people with HCV infection feel well or only have non-specific symptoms, early diagnosis requires targeted testing of all people who are at risk of previous exposure to HCV

• 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  Iives’.

This report should have been released months ago and the country can’t afford to wait to implement improvements. Absolute BS that it doesn’t in clued a implementation plan.

Its’ another reasonable report onHepatitis c in New Zealand it is a shame it will never be acted on and people will die and they will die increasingly in large numbers and they will die utterly preventable deaths. unless there is a significant increase in testing, diagnosis and treatment the number of people with end-stage liver disease – that is decompensated cirrhosis and liver cancer – will continue to increase . We are looking at: unnecessary death.

Draft copy released under OIA 29 July 09

http://www.hcv.org.nz/hepatitiscstrategynz.pdf (3 mgb file)

Meanwhile in England Hepatitis C out of control

undiagnosed; too few of those diagnosed are receiving the recommended treatment; and there are worrying regional variations in hepatitis C healthcare and delivery of treatment across the country. Of particular concern is the number of new infections each year – more than five times the number of people being successfully treated – indicating that prevention methods are not working. Clearly, the management of hepatitis C is out of control.

http://www.hepcoutofcontrol.org.uk/home.html

Hepatitis C is not slowing down in New Zealand it’s growing exponentially

RECENT TRENDS IN ILLEGAL DRUG USE IN NEW ZEALAND, 2006

a frightening reality vividly evident in this report

http://www.ndp.govt.nz/moh.nsf/pagescm/1109/$File/idms-2006-final-report-v2.pdf

“Forty-six percent of the frequent drug users had used injection equipment

after someone else in the past six months”

15.7 Summary of injecting behaviour

Forty-six percent of the frequent drug users had used injection equipment after someone else in

the past six months

Thirty-five percent of the frequent drug users had not always used a new sterile needle and

syringe when injecting drugs in the previous six months

The prevention effort of needle exchanges may have slowed the epidemic but even that seems questionable with behavior like above, the ongoing failure to address the problem is costing New Zealand dearly and is going to continue unless something is done.

Increase prevention efforts audit needle exchanges to optimise their services.

Anonymous community pharmacy blood testing for hep C  to try and reach the %75 of New Zealanders who are undiagnosed.

Show some leadership Ministry of Health and follow through invest in testing diagnosis and treatment.

best of health

www.hcv.org.nz

July 8, 2009

Hepatitis C New Service Improvements “delayed”

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , , , — admin @ 2:24 pm

In the 2009 Health Budget

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.

Hep C Service Improvements Cancelled

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 DHB read 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.

best of health

www.hcv.org.nz

July 2, 2009

Treatment waiting and liver fibrosis Hepatitis C New Zealand

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , — admin @ 6:02 pm

July 2009

Treatment flow chart

I’ve been studying this Treatment flow chart from a New Zealand District Health board.

hepatitis C treatment-flowchart
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

Best of Health

www.hcv.org.nz

June 23, 2009

Treatment responses Hepatitis C

Filed under: Hepatitis C New Zealand — Tags: , , , , , , , , , , , , , , , , , , — admin @ 1:54 pm

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

http://www.hepc.org.au/documents/2009WYNTKweb-2MB.pdf

this info is from the new hep c council of NSW website  http://www.hepc.org.au/index.php?article=content/home

well worth a look.

Some Hepatitis C related video’s this blog


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

best of health

www.hcv.org.nz

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 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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