Transcript The perspective of a person with HCV on new treatments

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
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My history
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Why I’ve been asked.
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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
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An individuals perspective on new treatments.
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The questions:
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Reimbursement?
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Access?
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Are they as good as the sales pitch?
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Treatment as prevention – Context
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National Hepatitis C Strategies - Prevention gaps
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24 hour access
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Criminalisation of drug use
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Self administration
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Provision of information and education about safe injecting
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Providing equipment other than needles and syringes
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Peer distribution
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Reduced stigma
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Raised general community awareness about hepatitis C
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Treatment as prevention – Context
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Hepatitis C treatment access and uptake for people who inject drugs: a review
mapping the role of social factors. Magdalena Harris and Tim Rhodes
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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
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(Good testing rates)
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Failure of treatment services
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Treatment no longer clinically indicated
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Nothing stopping people who inject being treated already except access to
health services, stigma and discrimination
Barriers to access for people generally
Ethics
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Motivation for participating
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Is the primary benefit to the individual or public?
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Hepatitis C as a benign infection
What consent/coercion?
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What happens to people who are offered to participate, and who don’t
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Self-perception - more stigmatisation; guilt; shame
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Treatment as prevention: The questions
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Does hepatitis C treatment as prevention change the relationship of hepatitis C with
people who inject drugs
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Why fear if you can be treated easily?
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How often is a person allowed to be treated?
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Will people who inject take more risks in injecting because hepatitis C becomes
a treatable illness?
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Does hepatitis C treatment become like antibiotics?
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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
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What impact does this have for the rest of their lives
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Confidentiality now and in the future
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Treatment as Prevention: The costs
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People become patients
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Loss of autonomy
Treatment as prevention = hepatitis B vaccination
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Chronic infection
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Prevention as a clinical issue
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The lack of advocacy for other issue
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Better access to clean injecting equipment
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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?
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Thank you