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Transcript
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
Introduction/Disclaimers
•
My history
•
Why I’ve been asked.
2
One individuals perspective on new treatments.
• 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
La Trobe University
3
An individuals perspective on new treatments.
•
The questions:
•
Reimbursement?
•
Access?
•
Are they as good as the sales pitch?
4
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
5
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
6
Treatment as prevention: Some implications
•
(Good testing rates)
•
Failure of treatment services
•
•
Treatment no longer clinically indicated
•
•
Nothing stopping people who inject being treated already except access to
health services, stigma and discrimination
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
7
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
8
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?
9
Thank you