1. Hepatitis C in Retrospect David Gladders Portsmouth City Council

2. Tackling Hepatitis C Preventing infection Raising awareness of infection Increasing access to treatment Ensuring infected individuals access treatment Source: Hepatitis C in the UK. Public Health England 2013

3. Hepatitis C Transmission Hepatitis C is a blood borne virus High risk for HCV transmission – IV /snorting drug use- sharing any equipment – Tattoos and Piercings – Medical and dental treatment abroad – Blood transfusion pre 1992 Low transmission risk for HCV transmission – Sexual transmission approximately 1.5%. – 3% risk in gay sex – Mother to baby in presence of HIV coinfection <3%

4. What does Hepatitis C do? Hepatitis C causes damage to the liver. Hepatitis C clearance can reverse associated mild/moderate liver damage If left untreated Hepatitis C can cause cirrhosis- irreversible damage to the liver and increases the risk of liver cancer. Hepatitis C has been linked to symptoms of night sweats, brain fog and depression. Infection does not cause specific symptoms

5. Hepatitis C testing Hepatitis C Antibody Should be offered to anyone who has been put at risk Is not useful for anyone who knows they either have or have had the virus Tells us if the person has ever been infected with Hepatitis C Can be performed on oral swab, blood spot or blood test

6. Oral swab testing: -Hepatitis C Antibody -Result in 20-40 minutes Oral Swab Testing

7. Hepatitis C RNA Positive result indicates that the patient still has the virus. Negative result with positive antibody suggests that the virus has been cleared with treatment or that the person has cleared the virus themselves (15-20% of cases)

8. Genotypes There are several strains of hepatitis C called Genotype. Genotype 1-6. Genotype 1 and 3 most common in UK Affects the type of treatment offered to people Effects response to treatment Genotype is determined by blood test

9. Assessment Of Liver Damage And Preparation For Treatment Ultrasound scan of liver Fibroscan of liver Blood tests Medical history Assessment of psychosocial history past and present Assessment of current psychosocial support

10. What is the treatment? Pegylated Interferon- self administered injection in pen form Ribavirin- tablets twice daily Protease inhibitor- tablets either four times daily or twice daily for Genotype 1 only. Must be taken on time and with high fat snack. 6 month treatment for most patients- 75% chance of clearance if treatment naive

11. Treatment Hepatitis C is cleared with treatment in 60- 80% of people Treatment usually lasts 6 months Treatment may be extended due to viral response or extent of liver damage at start of treatment Drug and alcohol use does not mean you cant have treatment

12. Main Side Effects of Treatment Fatigue Shortness of breath Muscle and Joint aches Feeling flu like for 24-48 hours after injection Lowered mood, irritability Difficulty sleeping Ano rectal itch, diarrhoea, nausea

13. Pathways For People Who Test Positive For Hepatitis C Antibody Antibody positive Refer to nurses for confirmatory Hepatitis C RNA test. Advise of Hepatitis C support group Assessment for liver damage and discussion re treatment options in nurse led clinic Consultant appointmentTreatment

14. Avalon centre Gosport War memorial QA Hospital St Marys Hospital Orion Centre HCV Outreach Clinics Outreach clinics have improved access to specialist HCV services for vulnerable groups.

15. Hepatology Nurse led outreach clinics 2013

16. Portsmouth City HCV Screening Day Sept 2013 Organized by Peer educator lead – Dave Gladders & Portsmouth City Council Attend 1hr education session 113 PWID tested 37 oral mouth swab Ab positive 11 have returned for HCV RNA testing over past 4 months – ( 10 positive 1 negative) 76 negatives were advised to have repeat testing 3 months – letters sent out 3 months after event How many have addressed substance misuse ??

17. Dispelling the myths Treatment is available Everyone testing positive for hepatitis C will be considered for treatment Drug use and Alcohol use is not a reason to not offer treatment if person is stable Liver biopsy is rarely needed before treatment Treatment can be accessed locally

18. Support group Aim: to provide emotional support to people contemplating testing and on treatment. Universality is why people respond well to support groups Advantageous to run groups alongside nurse treatment clinics where possible A team approach is imperative.

19. Recovery and Treatment Hepatitis C Diagnosis is an anxious time Potential for return to learned behaviours is high Talking therapies can compliment medical treatment

20. Confidentiality And The Installation Of Hope People need to feel safe and listened to without judgement Patients learn from others to believe in the process Hope has a positive impact on a patients journey through treatment

21. Catharsis Expressing suppressed thoughts and feelings is healing. Sharing feelings in a group leads to feelings of belonging and self worth Positive thinking can help people believe that they can cope with treatment and improves compliance to medication.

22. Thank you for your time