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

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Introduction/Disclaimers

• My history

• Why I’ve been asked.

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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

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An individuals perspective on new treatments.

• The questions:

• Reimbursement?

• Access?

• Are they as good as the sales pitch?

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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

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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

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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

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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

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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