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Hepatitis C in Retrospect

Hepatitis C in Retrospect. David Gladders Portsmouth City Council. Tackling Hepatitis C. Preventing infection Raising awareness of infection Increasing access to treatment Ensuring infected individuals access treatment. Source: Hepatitis C in the UK. Public Health England 2013.

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Hepatitis C in Retrospect

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  1. Hepatitis Cin Retrospect David Gladders Portsmouth City Council

  2. Tackling Hepatitis C • Preventing infection • Raising awareness of infection • Increasing access to treatment • Ensuring infected individuals access treatment Source: Hepatitis C in the UK. Public Health England 2013

  3. Hepatitis C Transmission • Hepatitis C is a blood borne virus • High risk for HCV transmission • IV /snorting drug use- sharing any equipment • Tattoos and Piercings • Medical and dental treatment abroad • Blood transfusion pre 1992 • Low transmission risk for HCV transmission • Sexual transmission approximately 1.5%. • 3% risk in gay sex • Mother to baby in presence of HIV coinfection <3%

  4. What does Hepatitis C do? • Hepatitis C causes damage to the liver. • Hepatitis C clearance can reverse associated mild/moderate liver damage • If left untreated Hepatitis C can cause cirrhosis- irreversible damage to the liver and increases the risk of liver cancer. • Hepatitis C has been linked to symptoms of night sweats, brain fog and depression. • Infection does not cause specific symptoms

  5. Hepatitis C testing • Hepatitis C Antibody • Should be offered to anyone who has been put at risk • Is not useful for anyone who knows they either have or have had the virus • Tells us if the person has ever been infected with Hepatitis C • Can be performed on oral swab, blood spot or blood test

  6. Oral Swab Testing Oral swab testing: -Hepatitis C Antibody -Result in 20-40 minutes

  7. Hepatitis C RNA • Positive result indicates that the patient still has the virus. • Negative result with positive antibody suggests that the virus has been cleared with treatment or that the person has cleared the virus themselves (15-20% of cases)

  8. Genotypes • There are several strains of hepatitis C called Genotype. • Genotype 1-6. • Genotype 1 and 3 most common in UK • Affects the type of treatment offered to people • Effects response to treatment • Genotype is determined by blood test

  9. Assessment Of Liver Damage And Preparation For Treatment • Ultrasound scan of liver • Fibroscan of liver • Blood tests • Medical history • Assessment of psychosocial history past and present • Assessment of current psychosocial support

  10. What is the treatment? • Pegylated Interferon- self administered injection in pen form • Ribavirin- tablets twice daily • Protease inhibitor- tablets either four times daily or twice daily for Genotype 1 only. Must be taken on time and with high fat snack. • 6 month treatment for most patients- 75% chance of clearance if treatment naive

  11. Treatment • Hepatitis C is cleared with treatment in 60-80% of people • Treatment usually lasts 6 months • Treatment may be extended due to viral response or extent of liver damage at start of treatment • Drug and alcohol use does not mean you cant have treatment

  12. Main Side Effects of Treatment • Fatigue • Shortness of breath • Muscle and Joint aches • Feeling flu like for 24-48 hours after injection • Lowered mood, irritability • Difficulty sleeping • Ano rectal itch, diarrhoea, nausea

  13. Pathways For People Who Test Positive For Hepatitis C Antibody

  14. HCV Outreach Clinics Outreach clinics have improved access to specialist HCV services for vulnerable groups. Orion Centre Avalon centre QA Hospital St Marys Hospital Gosport War memorial

  15. Hepatology Nurse led outreach clinics 2013

  16. Portsmouth City HCV Screening Day Sept 2013 • Organized by Peer educator lead –Dave Gladders & Portsmouth City Council • Attend 1hr education session • 113 PWID tested • 37 oral mouth swab Ab positive • 11 have returned for HCV RNA testing over past 4 months • ( 10 positive 1 negative) • 76 negatives were advised to have repeat testing 3 months – letters sent out 3 months after event • How many have addressed substance misuse??

  17. Dispelling the myths • Treatment is available • Everyone testing positive for hepatitis C will be considered for treatment • Drug use and Alcohol use is not a reason to not offer treatment if person is stable • Liver biopsy is rarely needed before treatment • Treatment can be accessed locally

  18. Support group • Aim: to provide emotional support to people contemplating testing and on treatment. • Universality is why people respond well to support groups • Advantageous to run groups alongside nurse treatment clinics where possible • A team approach is imperative.

  19. Recovery and Treatment • Hepatitis C Diagnosis is an anxious time • Potential for return to learned behaviours is high • Talking therapies can compliment medical treatment

  20. Confidentiality And The Installation Of Hope • People need to feel safe and listened to without judgement • Patients learn from others to believe in the process • Hope has a positive impact on a patients journey through treatment

  21. Catharsis • Expressing suppressed thoughts and feelings is healing. • Sharing feelings in a group leads to feelings of belonging and self worth • Positive thinking can help people believe that they can cope with treatment and improves compliance to medication.

  22. Thank you for your time

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