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The perspective of a person with hepatitis C on new treatments and treatment as prevention
Jack Wallace, Research Fellow.
Australian Research Centre in Sex, Health and Society
2
Introduction/Disclaimers
• My history
• Why I’ve been asked.
3
One individuals perspective on new treatments.
La Trobe University
• There is a strong level of interest among my cohort of people with hepatitis C about the changes to hepatitis C treatments
• The horror stories of interferon
• Peg-interferon
• The possibilities of combination therapy
• Dumping of liver biopsy
• Fibroscan
• IL28
• New interferon free treatments
4
An individuals perspective on new treatments.
• The questions:
• Reimbursement?
• Access?
• Are they as good as the sales pitch?
5
Treatment as prevention – Context
• National Hepatitis C Strategies - Prevention gaps
• 24 hour access
• Criminalisation of drug use
• Self administration• Provision of information and education about safe injecting• Providing equipment other than needles and syringes• Peer distribution
• Reduced stigma
• Raised general community awareness about hepatitis C
6
Treatment as prevention – Context
• Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Magdalena Harris and Tim Rhodes
• Issues taking precedence over hepatitis C treatment or prevention• Poverty• Homelessness• Funding and maintaining an illicit drug dependency • Fear of arrest and incarceration• Needle and syringe access• OST provision and restrictions • Managing childcare and possible child removal • Stigma and social isolation • Distrust of police and health care services• Self management of acute and ongoing health concerns (such as soft tissue
infections, drug withdrawal, overdose and depression) • Interpersonal violence
7
Treatment as prevention: Some implications
• (Good testing rates)
• Failure of treatment services
• Nothing stopping people who inject being treated already except access to health services, stigma and discrimination
• Treatment no longer clinically indicated
• Barriers to access for people generally
• Ethics
• Motivation for participating
• Is the primary benefit to the individual or public?• Hepatitis C as a benign infection
• What consent/coercion?
• What happens to people who are offered to participate, and who don’t• Self-perception - more stigmatisation; guilt; shame
8
Treatment as prevention: The questions
• Does hepatitis C treatment as prevention change the relationship of hepatitis C with people who inject drugs
• Why fear if you can be treated easily?
• How often is a person allowed to be treated?
• Will people who inject take more risks in injecting because hepatitis C becomes a treatable illness?
• Does hepatitis C treatment become like antibiotics?
• How does affect treatment access to other people with hepatitis C who do not fall into the group being treated - a lot of whom want to be treated
• What impact does this have for the rest of their lives
• Confidentiality now and in the future
9
Treatment as Prevention: The costs
• People become patients
• Loss of autonomy
• Treatment as prevention = hepatitis B vaccination
• Chronic infection
• Prevention as a clinical issue
• The lack of advocacy for other issue
• Better access to clean injecting equipment
• Broadening access to treatment services – the move of treatment into general practice or community based health services
• Is this the best way of reducing the public health burden of viral hepatitis in Australia?
Thank you
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