- Release of the first national report on progress towards eliminating hepatitis C
- New Hepatitis NSW CEO Announced – Stuart Loveday retiring
- Community mobilisation – Engaging people in hep B testing and care
- Posters and presentations at AVHEC highlight Hepatitis NSW’s community and peer work
- Changes to health screening requirements for visa applicants
Release of the first national report on progress towards eliminating hepatitis C
While Australia has made great strides towards hepatitis C elimination in the past three years, to achieve this goal there is a need to monitor progress and identify and address challenges and barriers along the way.
To better examine progress and challenges, the Burnet and Kirby Institutes, working with key partners, have published Australia’s progress towards hepatitis C elimination. The report brings together data from separate sources across Australia, from publicly available datasets through to mathematical modelling to give an overview on progress towards eliminating hepatitis C in Australia. The report highlights gaps in our knowledge and informs future directions in Australia’s hepatitis C elimination response. Future reports will aim to gather further data for all priority populations and specific settings.
The report shows the number of hepatitis C treatment initiations in Australia increased significantly after the listing of new cures on the Pharmaceutical Benefits Scheme in March 2016; approximately 70,000 people were treated by the end of 2018. There has also been a decline in new infections of hepatitis C. However, approximately two-thirds of the estimated population living with hepatitis C is yet to be treated. Of concern, the report shows a decline in the number of people receiving HCV- RNA testing for treatment work up, and a slowing of treatment uptake which indicates a need to improve efforts to help people into diagnostic testing and with linkage to care. It is believed that without efforts to significantly increase testing of at-risk populations and prevent further treatment declines, Australia’s progress towards elimination of hepatitis C will slow.
Board President, Dr Denise Jarratt, has announced that Mr Steven Drew has been appointed as the new CEO of Hepatitis NSW, commencing on 1 October 2019.
Steven has held a number of senior appointments throughout his career. These include ten years as CEO of the Pharmaceutical Society of NSW and of the Pharmaceutical Society of Australia Limited (NSW Branch), working in the NSW Attorney’s General Department as Director of Crime Prevention, working with cabinet ministers and as a non-executive director on several Boards.
Dr Jarratt advised that Steven brings exceptionally strong skills and capacity in the areas of leadership, management, networking, partnership, engaging political engagement, advocacy, communication, strategic management, and strategy development.
Steven will be working with outgoing CEO Stuart Loveday during a short handover period. Stuart has confirmed he will formally retire from Hepatitis NSW on 29 October 2019.
Stuart leaves with our heartfelt thanks and appreciation for 25 years of incredible service to Hepatitis NSW and to the communities of people affected by hepatitis C and hepatitis B in NSW.
Community mobilisation: Engaging people in hep B testing and care
Outgoing Hepatitis CEO, Stuart Loveday, spoke at the 2019 Australian Viral Hepatitis Elimination Conference on mobilisation of communities of people living with hepatitis B or with hepatitis C. This is a summary of the hepatitis B part of his talk (the hepatitis C component will be published next edition).
Many factors influence the mobilisation of people into health seeking behaviours – in this case, to seek out testing, liver health monitoring, good health maintenance and treatment for hepatitis B.
NSW has done exceptionally well in terms of its immunisation/vaccine program, with child and infant immunisation rates beating their stated targets in the mid-to-high 90% levels.
Where we have not done at all well is in terms of supporting people living with hepatitis B into testing, liver health monitoring and, where needed, treatment:
- 234,000 people living with chronic hepatitis B in Australia.
- 64% have been diagnosed; 36% remain undiagnosed.
- Of those people diagnosed, only 20% are engaged in care (target 50% by 2022).
- 8% are receiving treatment, however the target is 20% by 2022.
(Viral Hepatitis Mapping Project National 2017, released in 2019)
Progress is being made – but it is not enough and it is too slow, as we are not reaching National Strategy targets.
Professor Greg Dore stated, at the launch in NSW of World Hepatitis Day 2019 and NSW Hepatitis Awareness Week, that “every death from hepatitis B (where late diagnosis of advanced liver disease is involved) represents a policy failure.” This is a sobering and sad indictment. In 2019, we should not be at that stage still in Australia.
Men and women in their 40s, 50s, 60s and older continue to be diagnosed with late stage liver disease – including advanced cancer – and their families continue to be shocked that things could progress so far, often with little or no prior indication of illness, and are devastated by the resulting loss of their family member.
While acknowledging that hep B impacts proportionally far more on Aboriginal and Torres Strait Islander people in NSW and Australia than on non-Indigenous Australians, we will focus here on those people who have moved to Australia from countries of high hep B prevalence.
New South Wales has 15 geographical Local Health Districts (LHDs) as part of the NSW Health Department. Of these:
- The overwhelming majority of people living with hep B live in five LHDs in Sydney, the prevalence of hep B in those LHDs is high.
- NSW Health have made a very welcome investment to fund a nurse position in each of those five LHDs.
- Funding ends at the end of June 2020, and we do not know whether either the Ministry or those five LHDs will continue to employ those dedicated nurse positions.
From a community awareness and mobilisation point of view, there has been extremely limited resourcing provided by the government, especially when compared with investments in the responses to HIV and, more recently and to a lesser extent, to hepatitis C.
We know what works in terms of resourcing to community-based organisations. This has been demonstrated in previously funded hep B projects in NSW, such as NSW Health funding for the NSW Cancer Council to work with Vietnamese communities in south west Sydney, and Commonwealth funding (via Hepatitis Australia) that allowed Hepatitis NSW to work with Chinese-Australian and Korean-Australian communities in high prevalence areas of Sydney.
With relatively small amounts of funding provided to state-wide agencies, like Hepatitis NSW or Cancer Council NSW, the value added outcomes generated by input from those partner organisations and communities is something that must be recognised by governments: that is one of the key reasons for, and benefits of, funding community based organisations.
Working with communities affected by hepatitis B is so very different from the work that Hepatitis NSW and our partner agencies have done on behalf of and with people living with hep C.
Firstly, there are the cultural approaches to health and liver health specifically.
Then, each community – be they older migrants from China, other countries in Asia the Pacific Islands or Sub-Saharan Africa – require individualised approaches based on their own communities’ needs and culture. Responses and services must be developed in conjunction with and from within those communities.
The role that the family plays is integral to health outcomes. They can make or break health outcomes. Hepatitis B is certainly family business. Stigma and unwitting discrimination – which is very different from the stigma and discrimination surrounding hepatitis C – is very much at play.
And the buy-in from community-based partners – previously not associated at all with hepatitis B – is a huge bonus: in terms of capacity, optimism, outcomes, and bang for buck.
However, unfortunately, the very programs that were shown to mobilise those targeted communities with hepatitis B into testing and care, are no longer funded by either the Commonwealth or NSW governments.
Hepatitis B has been the very poor cousin of hepatitis C when it comes to targeted interventions to improve the lives of those people living with hep B. We must recognise this and, in addition to other interventions, provide funding and resource community organisations across Australia to work in partnership with priority populations. If we are to stop the policy failures and save the lives of migrant populations living with hepatitis B, this is perhaps the greatest challenge of all.
Posters and presentations at AVHEC highlight Hepatitis NSW’s community and peer work
Hepatitis NSW had three posters on display at the 2019 Australasian Viral Hepatitis Elimination Conference (AVHEC) held at Sydney’s Brighton Le Sands in August. The large, colourful posters were a great opportunity to highlight and promote several significant projects we’ve undertaken this last year. There was also a presentation given on the Dried Blood Spot Testing stall held at the Byron Bay Bluesfest during Easter 2019. Here is an overview:
Addressing stigma associated with hepatitis B among Chinese and Korean Australians: Family Health and Cancer Prevention [Poster]
Health promotion events with broad appeal strengthen the opportunity to deliver key health messages, including that hepatitis B is completely preventable and treatable. This poster describes how providing a holistic health and family health approach to health promotion successfully breaks down stigma and discrimination improving attendance and engagement among Chinese and Korean Australians.
Download>>> CLICK HERE
Let’s Stick Together to Close the Gap [Poster]
This poster outlines the work of Close The Gap 414 – a joint partnership between Hepatitis NSW and other organisations at 414 Elizabeth St, Surry Hills, to improve outcomes for Aboriginal and Torres Strait Islander people. Close The Gap 414 partner organisation’s communities overlap and, by working together, we provide holistic and integrated health promotion programs. Pooling our financial and staff resources allows for a coordinated approach and builds capacity for future work. The camaraderie and shared commitment to improving health outcomes by Close The Gap 414 Indigenous staff is integral to the program’s success.
Download>>> CLICK HERE
The value of a peer and clinical partnership to facilitate hepatitis C healthcare access in priority settings [Poster]
The long-term aim of regular, consistent peer support and on-site hepatitis healthcare is service-based micro elimination of hepatitis C. This poster discusses how, by providing immediate and simplified access to onsite healthcare, our Live Hep C Free project helps alleviate the difficulty some people face in navigating the health system by meeting people where they’re at with the healthcare they need.
Download>>> CLICK HERE
Hepatitis C is a Rock N Roll Brand – Taking DBS Testing to Bluesfest [Presentation]
Providing Dried Blood Spot (DBS) testing within a music festival daily until 10 pm gave access to a diverse range of people not previously tested. The visibility of hepatitis C services and accessibility of DBS testing was positive providing and easy-to-access, on-the-spot service. Nurses, educators, counsellors, and community staff acted as a bridge to festival goers.
Download slideshow>>> CLICK HERE
Changes to health screening requirements for visa applicants
There have been some recent changes to health screening requirements for people applying to migrate to Australia. The changes are quite significant, and will hopefully reduce the amount of discrimination that people living with viral hepatitis (notably hepatitis B) have been subjected to when applying for Permanent Residence status or other visa classes.
Where previously visa applications were rejected, if it was assessed that the medical condition was likely to cost more than $40,000 over the lifetime of the applicant, this has now been changed to $49,000 over a ten-year period.
Hepatitis NSW understands it is likely this will benefit everyone seeking permanent residency; particularly those who are entering Australia as students or on work visas seeking to obtain residency, plus those migrating under non-humanitarian streams (in other words, the vast majority of migrants). Unfortunately, those with advanced liver disease seeking residency will likely remain in question under the new regulations. It is expected that once someone has decompensated cirrhosis, they would still be excluded.
Hepatitis Victoria has a range of updated resources available>>> CLICK HERE