Hepatitis C New Zealand

December 14, 2009

Hepatitis C New Zealand laboratory notification

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

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

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

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

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

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

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

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

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

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

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

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

Some don’t seek hepatitis C treatment

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

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

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

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

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

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

Hep c new treatment tested New Zealand

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

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

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

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

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

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

Health Cheque

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

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

Health Cheque link

NZ Needle exchange success

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

scoop here

Injecting, Infection, Illness: Abjection and Hepatitis C Stigma

Magdalena Harris

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

Magdalena discuses ways in which this stigmas is constituted

Three components central to hepatitis C stigma

1. illicit injecting

2. infectiousness and

3. societal aversion to chronic illness

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

Injecting, Infection, Illness: Abjection and Hepatitis C Stigma

Get tested campaign

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

Get Tested! from Ross Aitken on Vimeo.

Have a great Holiday season

Best of health

www.hcv.org.nz

May 9, 2009

New Zealand District Health Boards and Hepatitis C

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

April 30, 2009

How many people in New Zealand have Hepatitis C ?

How many people in New Zealand have Hepatitis C ?

holiday

The often quoted 50,000 New Zealanders’ with HCV figure derives from a study, Hepatitis C infection in New Zealand: Estimating the current and future prevalence and impact July 2000

The objective of this project was to estimate the number of people in New Zealand who are currently infected with the hepatitis C virus (HCV) and how many are likely to become infected up until the year 2010. It also aimed to project how many people are expected to develop HCV-related liver disease.

The study uses a model developed by the National Centre in HIV Epidemiology and Clinical Research in Australia. The model was modified to reflect the epidemiology of HCV infection and injecting drug use in New Zealand. It is based on estimating the number of people who have used injecting drugs over time and determining the incidence of HCV as a result of this. These estimates were adjusted for transmission from other routes including the receipt of HCV-infected blood and blood products.

The estimates and projections from the model must be interpreted with caution as there are limited New Zealand data for the input variables of the model.

So lots of assumptions later and with lots of qualifying statements we have the guesstimate of 50,000 Zealanders’ with HCV the truth no one knows ?

Australian study

An Australian led, international clinical trial, being presented at the European Association for the Study of the Liver Congress in Copenhagen this week has highlighted the benefits of treating hepatitis C sooner, rather than later.

The study involved more than 700 Australians with hepatitis C and 33 Australian hospitals. It found people living with the most common strain of hepatitis C who receive treatment when there is minimal, or no liver damage, may double their chance of a cure, compared to those treated in the later stages, where liver damage has become more advanced.

“We found that that up to seven out of ten people, with the most common strain of hepatitis C (called genotype 1), may be cured if treatment starts before liver scarring or damage has occurred.”

Associate Professor Stuart Roberts, Director of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne

More here

Christchurch Hepatitis C Community Clinic

Christchurch Hepatitis C Community Clinic, Information about clinic and interview with nurse Jenny Burke and from Christchurch Hepatitis C resource Centre in their Connexion magazine reproduced here.

http://www.hcv.org.nz/christchurchclinicjbourke.html

The clinic has opened in partnership with the Christchurch needle exchange, The Rodger Wright Centre. Personally I would rather go to a GP / hospital to access health services.

I was at a party recently when a old friend approached me and told me about getting a blood test at one. She was not impressed, She is in recovery (staunch NA person lots’ of regular meetings etc) she described the experience as making her feel like a junky again and that the person couldn’t get a blood sample from her despite numerous tries.

For people who are immersed in the sad reality of drug use Community Clinics may be the only way they can access health care and it is important to cater for these disadvantaged groups if we are to effectively address Hepatitis C epidemic in New Zealand.

The claim it is the first community hepatitis C clinic in NZ is somewhat dubious as it appears to offer no treatment just referrals for treatment.

The European Association of the Study of Liver Disease wrapped up on Sunday in Copenhagen. Some new drugs and studies revealed at EASL in Copenhagen EASL , here are some of the highlights of all things hepatitis C including

Roche, InterMune(ITMN Quote) and Pharmasset(VRUS Quote) provided the most eagerly anticipated clinical data of the conference Saturday with results from a 14-day trial combining two experimental direct antivirals — InterMune’s ITMN-191 with Pharmasset’s R7128 — given to patients with treatment-naïve hepatitis C. Roche is a development partner on both drugs.

telaprevir is capable of significantly improving cure rates in the most difficult-to-treat patients who had failed prior treatment with the current standard drug regimen for hepatitis C — a 48-week course of long-acting interferon plus ribavirin.

This data keeps telaprevir ahead of its hepatitis C rivals because no other drug has yet shown the ability to improve the cure rates for both patients new to therapy as well as those who have failed prior therapy.

Telaprevir was the “butt” of some negative EASL chatter due to an anecdotal report that the drug was causing severe anal itching in patient(s). One EASL attendee described the side effect as “fire in the hole.”

More here

http://www.thestreet.com/story/10492231/1/hepatitis-c-updates-from-easl-liver-confab.html

World Hepatitis Day coming up Tuesday, May 19, 2009

www.hcv.org decided to celebrate World Hepatitis Day by finding out how many people in New Zealand are treated and what level of care and treatment and support is available.

We sent letters to all District health boards and are hoping to get back replies and post them up in next month or so.

It is inspired by a recent study of Asthma care in NZ http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10556507

Otago and Canterbury were done earlier and their replies here.

http://www.hcv.org.nz/CHCHOIA08.html

http://www.hcv.org.nz/otagoaudit08.html

Best of Health

www.hcv.org.nz

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