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THE number of hepatitis C patients receiving treatment needs to double within five years just to stop the existing flow of cases of liver cirrhosis and liver cancer from turning into a flood, an official review has concluded. Hepatitis C -- a viral disease that attacks the liver, and which is most often transmitted via sharing needles -- ranks as the most commonly notified infectious disease in Australia over the past 10 years. It is estimated that over 260,000 people in Australia carried the infection in 2005. But a long-awaited review of treatment services commissioned by NSW Health has concluded that if the numbers of people receiving treatment remains at its 2005 level of 2000 patients, "the number of people living with chronic HCV and more advanced-stage liver disease or cirrhosis are projected to increase by around 38 per cent by 2015". The report says the number of patients treated each year would need to reach 6000 to prevent the expected increases in people with advanced liver disease. Although treatment rates have risen since 2005, it is now estimated that about 3500 people a year are being treated for HCV infection in Australia -- meaning the number still has to rise substantially to ensure hospitals are not overwhelmed by patients needing treatment for liver failure that could have been prevented. Stuart Loveday, executive officer of the Hepatitis C Council of NSW, says the most pressing need is to recruit more nurses and psychologists to help HCV patients get through the arduous year-long treatment.
"The side effects can be exceptionally debilitating. They can cause massive mood swings," Loveday said. "Hepatitis C itself causes depression, but the treatment can worsen that, and suicides have occurred on a number of occasions on hep C treatment. Really, it's the nurses who are in demand." Greg Dore, head of the viral hepatitis clinical research program at the National Centre in HIV Epidemiology and Clinical Research, says although commissioned in NSW, where 40 per cent of the country's new HCV cases are reported, the report's findings apply to every other state except Queensland. Although more patients had been coming forward for treatment since a requirement to first have a liver biopsy was lifted in 2005, capacity in the system has not been increased and "clinics are full at the moment", he says. "Apart from Queensland, where they have injected a fair bit of money into (recruiting more) clinical nurse consultants, things are pretty much the same in other jurisdictions," associate professor Dore said. As well as recruiting more nurses and psychologists, other doctors -- such as sexual health physicians and doctors working in methadone clinics -- could also be used to deliver hepatitis C treatments, he said. Acting chief medical officer of NSW Health Kerry Chant says the department is "looking at how best to respond and implement the recommendations in the report".
Chant says NSW Health has already agreed to boost health service budgets by an extra $800,000 in recurrent funding to support HCV patients. An extra $250,000 in recurrent funding has also been given to the Hepatitis C Council of NSW for health promotion initiatives, and $290,000 to the Australasian Society for HIV Medicine to train GPs to prescribe hepatitis C drugs.
Work has also begun on developing a revised model of care for hepatitis C treatment, in line with the recommendations, including the funding of pilot sites to trial provision of hepatitis C treatment through alcohol and other drug services.
Doctors with prescribing rights for hepatitis C treatment will also get free supplies of hepatitis B vaccine -- a three-dose vaccine that normally requires one or more doses to be bought on private prescription -- "to improve broader health outcomes for people with hepatitis C".
The 120-page report found most HCV treatment services reported having no spare capacity to increase numbers of patients receiving treatment, and most funding came from multiple sources and was non-recurrent -- a point that hinders recruitment efforts, because candidates are deterred by the reduced job security.
The report also found treatment services were scarcer in rural areas, and a number of groups -- including prisoners, children and indigenous people -- found it harder to access treatment.
Helen Tyrrell, CEO of Hepatitis Australia, says the report is "to my knowledge the first really comprehensive review of the treatment and care services in any of the states" for at least five years. As NSW accounts for nearly half of all HCV cases, "if NSW can make some inroads here, it's going to have some impact on the national figures".
"Unless we get numbers of new transmissions per year below the number who are treated and cured every year, we are not really winning," Tyrrell said.
"It's one thing for area health services to focus on treatment, but unless we are giving the same degree of scrutiny to what we are doing in prevention, we are only looking at half the picture." http://www.theaustralian.news.com.au
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