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Centerforce Hepatitis C-Infected Peer Health Educator Training

Centerforce Hepatitis C-Infected Peer Health Educator Training. DAY 2. Day 2 Schedule. By the end of this module, participants will have Located the liver in the human body Identified that the liver is a vital organ Identified at least 3 functions of the liver

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Centerforce Hepatitis C-Infected Peer Health Educator Training

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  1. Centerforce Hepatitis C-Infected Peer Health Educator Training DAY 2

  2. Day 2 Schedule

  3. By the end of this module, participants will have Located the liver in the human body Identified that the liver is a vital organ Identified at least 3 functions of the liver Identify at least 2 consequences associated with liver damage Module 3: Review of Liver Basics

  4. Location of the Liver

  5. Basic Liver Facts • The liver is a vital organ – we cannot live without a working liver • The liver is a “non-complaining organ”. • It can be damaged and you won’t feel it or have any symtpoms.

  6. Basic Liver Facts • The liver performs over 500 vital functions • The liver… • Processes almost everything a person eats, drinks, breathes, injects and/or absorbs through the skin. • Filters medications, drugs, alcohol, and harmful substances such as heavy metals and poisons • Stores vitamins and minerals (including vitamins A, D, K and B12) • Helps produce substances that make the blood clot when we get a cut

  7. Basic Liver Facts • The liver is the only organ in the body that can regenerate itself (but only RARELY and in special circumstances). • However if the liver faces continued, ongoing damage – liver tissue can • become fibrous (fibrosis) • scar (cirrhosis) • become fatty (steatosis)

  8. Review & Main Messages Let’s review • What is a vital organ? • List two things that your liver does for your body? • The liver is a “non-complaining organ” – what does that term mean? • Can the liver regenerate itself? • What can happen if the liver has to process a lot of substances over long periods of time, such as alcohol? • What were the three most important messages or “bottom lines” for you about the liver?

  9. Module 4: Review of Hepatitis C By the end of this module, participants will have Learned how a virus is transmitted in general Learned what Hepatitis is and what viral Hepatitis is Learned how the Hepatitis C virus is transmitted Identified at least three risk behaviors and protective behaviors for Hepatitis C Identified what a vaccine is and whether there is one for Hepatitis C

  10. The Three “Es” of Transmission of a Virus For a virus to be passed from one person to another, 3 things must happen. 1. A person has to be Exposed to someone who has the virus. So one of the individuals must be infected with the virus. 2. The behavior must be an Effective Method of Transmission (a way in which the virus can be transmitted from one person to another). 3. There must be Enough virus present in the body fluid for transmission. The specific body fluid is specific to each virus. For a cold virus, the body fluids are phlegm and saliva, for other viruses the body fluid is different.

  11. The Three “E’s” of Transmission of a Virus Exposedto someone who has the particular virus. Effectivemethod of transmission. Enoughof the virus present in the body fluid.

  12. What is “Hepatitis”? The term hepatitis means “inflammation of the liver” People can have an acute or chronic Hepatitis infection Acute infections last two weeks to six months and Chronic infections last longer than six months Hepatitis may be caused by viruses toxins (notably alcohol; overuse of over the counter, prescription or other drugs) other infections or from autoimmune process A person with hepatitis may or may not feel ill or sick

  13. Viral Hepatitis Viral hepatitis refers to a family of viral infections that affect the liver The most common types of viral hepatitis in the United States are hepatitis A, hepatitis B, and hepatitis C The symptoms of acute viral hepatitis A, B, and C are very similar to one another Many people with viral hepatitis have no symptoms.

  14. The Three “E’s” of Hepatitis C Transmission For the Hepatitis C virus to be passed from one person to another, 3 things must happen. 1. A person has to be Exposed to someone who has Hepatitis C. 2. The behavior must be an Effective Method of Transmission (a way in which the virus can be transmitted from one person to another). In the case of Hepatitis C, the effective methods of transmission are: -Blood to blood contact with someone that has Hepatitis C -There have been some cases of transmission of Hepatitis C during sex. 3. There must be Enough virus present in the body fluid for transmission. In the case of Hepatitis C, the body fluid that can pass Hepatitis C is BLOOD.

  15. Hepatitis C Virus Hepatitis C results in acute infections and very often in chronic infections Approximately 15-45% of adults infected with HCV are only acutely infected. Women: approx 40% of women only have an acute infection Men: approx 19% of men only have an acute infection Approximately 55-85% of adults infected with HCV become chronically infected If you treat the acute infection with interferon, the majority of people will clear the virus and not become chronically infected 15

  16. Hepatitis C Virus What body fluid transmits Hepatitis C? Blood How is Hepatitis C transmitted from one person to another? By having an opening in one’s body or skin exposed to the blood of someone infected with Hepatitis C. 16

  17. Hepatitis C Virus How do people get Hepatitis C? By Sharing: Needles for injecting drugs Any tattoo equipment (needles, guns, barrels, ink, etc). Cottons Crack pipes Tooters Razors, toothbrushes, clippers Injecting or snorting pills that may have been tucked inside someone else’s mouth ANYTHING that may have been exposed to blood 17

  18. Hepatitis C Virus Factors that put people at higher risk of contracting Hepatitis C through sex: Having multiple partners Co-infection with HIV or HBV Having herpes, lesions, sores, open cuts, wounds Having a sexually transmitted disease Specific sexual behaviors: Vampirism Fisting Cutting during sex Anal sex (blood is more likely to be generated during anal sex than during vaginal sex) 18

  19. Hepatitis C Virus Is there a vaccine for Hep C? NO! Prevention/Ways to reduce your risk: Don’t share anything that may have been exposed to blood Have only one sexual partner (be monogamous)—both of you need to get tested for Hepatitis C 19

  20. Hepatitis C Virus Myths about preventing transmission of Hepatitis C: Burning needles does not guarantee that you’ve killed Hepatitis C Cleaning needles and other equipment with bleach, etc does not guarantee that you’ve killed Hepatitis C Boiling needles, etc does not guarantee that you’ve killed Hepatitis C 20

  21. Hepatitis CReview & Main Messages • How long does a Hepatitis C infection last? • What percentage of adults who become infected have acute Hepatitis C and what percentage become chronically infected? • What body fluid is Hepatitis C found in? • Who has Hepatitis C in these body fluid? • How do people get Hepatitis C? • What’s a vaccine? • Is there a vaccine for Hepatitis C? • How do you prevent yourself from getting Hepatitis C? • If you’ve had Hepatitis C and cleared it, can you get it again? 21

  22. Hepatitis Roulette • Break up into X teams of Y players each. • Spend a few moments agreeing on a Team Name. • Each team will have 1 minute to respond to a question. The response should be from 1 team representative. • After XX minutes of game time, the team with the most points wins.

  23. Module 5: First Basic Hep C Tests By the end of this module, participants will be able to: • Identify the meaning of antibody test results • Identify the purpose of viral load tests • Identify the meaning and significance of high or low viral loads • Understand the purpose and importance of liver biopsies • Identify other tests for Hepatitis C and their purpose 23

  24. The first 3 basic tests for Hep C • Hep C Antibody Test • Tells you whether you have ever been infected with Hep C • If positive, yes you have • Does not tell you whether you have a current, active infection • Hep C Viral Load Test • This test does allow the doctor to see how much Hep C virus you have in your blood. • If you have any virus, you have a current, active infection. • Hep C Genotype Test • Tells the doctor what kind of Hep C you have. The options are genotype 1, 2, 3, 4, 5, or 6. • There are also sub-types, like type 2a for instance. 24

  25. Antibody test • Determines whether you have ever been exposed to HCV. • People who have been only acutely infected and cleared the virus will be positive on this test. • People who have been acutely infected and NOT cleared the virus (i.e., they are chronically infected) will also be positive on this test. 25

  26. Antibody test (cont’d): • Common test is the HCV ELISA test • Quick test for HCV antibodies just approved in 2011 • Home test that is anonymous • WINDOW PERIOD: 2-26 weeks 26

  27. Viral Load Test • Amount of virus in the blood • Confirms whether you have active infection • DOES NOT correlate with disease progression • DOES predict how well the medications will work • Confirms whether the treatment is working 27

  28. Viral Load Test • Measures the amount of Hep C circulating in the blood • Either expressed as copies/ml of blood or International Units (IUs) • There are different kinds of tests • Some are more sensitive than others • Laboratories use different technologies in testing. • Ideally, you should use the same lab for all of your tests. 28

  29. Viral Load Test Tells you whether the treatment is working • After 12 weeks of treatment, if there is either: • A 2-log drop in viral load OR • The virus is “undetectable” • Then the medication is working 29

  30. Viral Load Test Assessment of result of treatment • After 6 months following the end of treatment: • If there is no virus detected, this is called a “sustained virological response (SVR) • If virus is detected, this is called “viral breakthrough” and it means that the virus goes so low during treatment/by the end of treatment that it can’t be detected and then it “comes back” 6 months or more following the end of treatment 30

  31. Genotype tests Six major genotypes of HCV (plus sub-types) • Genotypes numbered 1, 2, 3, 4, 5, 6 (and 1a, 1b, etc) • HCV Genotype is a strong predictor of how well the treatment will work to get rid of it • Genotype 1 is the most common in the U.S. • 70% of the US population with HCV has Genotype 1 31

  32. Review & Main Messages Let’s review What does an antibody test tell you? What can an antibody test not tell you? What does a viral load test tell you? How many main genotypes are there of Hep C? 32

  33. Module 6: Treatment for HCV By the end of this module, participants will have: • Learned the General Treatment Guidelines • Learned the Pre-Treatment Predictors of Treatment Response • Learned the Goals of Treatment • Learned the average success rates of current treatments 33

  34. General Treatment Guidelines • In order to get onto treatment, the following conditions are generally required(*there are always exceptions so do not take this as an absolute required list. As always, see your doctor) • Overall health is stable • Have active, chronic HCV infection • Have elevated ALT’s (there are exceptions) • Compensated Liver Disease • For those with Decompensated Cirrhosis, treatment is generally only given in transplant centers. 34

  35. Pre-Treatment Predictors of Treatment Response* • Younger Age—younger than 40 • Low HCV RNA (Viral Load) • Women respond better than men • Healthy weight • Absence of fatty liver (steatosis) • Minimal liver damage—absent or mild fibrosis or cirrhosis • Minimal insulin resistance-no diabetes • Healthy immune system 35

  36. Why do people go on treatment? • To clear the virus out of the body • Sustained Virological Response (SVR) • HCV is undetectable during and 6 months following HCV medical therapy • 5 yr follow-up: less than 1% of people with SVR will have the virus come back • To improve inflammation and scarring • To slow disease progression • To improve symptoms and quality of life 36

  37. Response to Treatment* • Early Virologic Response (EVR): • 12 weeks into therapy they assess whether a patient has one of the following- • A 2 log drop in your viral load • Example: you go from 10,000,000 to 100,000 • Undetectable virus • IF a patient does not have either of these things occur 12 weeks into their treatment, then their doctor MAY discontinue treatment • End of treatment (EOT) response: • Undetectable at the end of treatment • Sustained Virologic Response (SVR): • Undetectable six months after treatment completion. 37

  38. Success of current Treatments* • The current treatments** available for Genotype 1: • Older treatment (only treatment available through April 2011): • approximately 40-50% of people have a SVR after undergoing 48 weeks (12 months, 1 year) of treatment • New treatment (available as of May 2011): • in general, approximately 66 – 79% of people have a SVR after undergoing 24-48 weeks (6 months to 8 months) of treatment *These are general success rates. Individual chances of success may vary. These are the success rates of treatment available as of May 2011.

  39. Treatments* • Older Treatment for Genotype 1 is: Pegylated Interferon + Ribavirin • New Treatment for Genotype 1 is: Protease Inhibitors + Pegylated Interferon + Ribavirin *These are general success rates. Individual chances of success may vary. These are the success rates of treatment available as of May 2011.

  40. Success of current Treatments* • The current treatments** available for Genotype 2, 3: • Approximately 70 – 82% of people have a SVR after undergoing 24 weeks (6 months) of treatment • The treatment for Genotype 2 & 3 is Pegylated Interferon + Ribivirin *These are general success rates. Individual chances of success may vary. These are the success rates of treatment available as of May 2011.

  41. Success Rates of New Treatments * • To date, the protease inhibitors or antiretrovirals have only been tested among those with Genotype 1 • Telaprevir (an antiretroviral or protease inhibitor) + pegylated Interferon + Ribavirin • For those who had never been treated: 79% of people had a SVR • For those who had been treated before: 86% of people had a SVR

  42. Success Rates of New Treatments* • Boceprevir (an antiretroviral or protease inhibitor) + pegylated Interferon + Ribivirin • For those who had never been treated: 66%of people had a SVR • For those who had been treated before: 66% of people had a SVR

  43. Success Rates of New Treatmentsfor African Americans* • Telaprevir • 62-88% SVR • Boceprevir • 42-53% SVR

  44. Hepatitis C TreatmentsReview & Main Messages • General Treatment Guidelines: in order to get on treatment, generally required that: • Overall health is stable • Have active, chronic Hep C • Have elevated ALT’s • Do not have decompensated cirrhosis 44

  45. Hepatitis C TreatmentsReview & Main Messages • Goals of Treatment • To clear the Hep C Virus from the body • To improve inflammation and scarring • To slow disease progression • To improve symptoms and quality of life 45

  46. Hepatitis C TreatmentsReview & Main Messages • Types of Current* Hep C Treatments: • For those with Genotype 1: antiretrovirals + pegylated Interferon + Ribavirin • For those with Genotypes 2 and 3: pegylated Interferon + Ribavirin • Old Treatment for Hep C Genotype 1: • Pegylated Interferon + Ribavirin 46

  47. Hepatitis C TreatmentsReview & Main Messages • AVERAGE Treatment Success Rates • For those with Genotype 1: • Current Treatment – • For those who have never been treated 66 to 79% of people have a SVR • For those who “failed” on prior treatments, 66 to 88% of people have a SVR • Older Treatment – • 40-50% of people have an SVR after 1 year of treatment • For those with Genotypes 2 & 3: • 70 - 82% of people have an SVR after 6 months of treatment 47

  48. Day 2: Wrap Up and Feedback • Thank you for your time and participation today • Outstanding questions • Review Parking Lot Items • Feedback Form: Please complete the Day 2 Feedback Form that is in your folder and turn it in before you leave • The next class is: ____________.

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