Vol 15 Edition 2

Needle and Syringe Programs: the ‘missing piece of the hepatitis C treatment puzzle’

People who currently inject drugs are at the same time the largest and least-treated segment of Australians living with chronic hepatitis C and must become a priority, reported Dr Stephen McNally, Deputy CEO of Penington Institute at their recent seminar ‘NSP: the missing piece of the hepatitis C treatment puzzle’.

“NSPs see people who inject drugs every day,” said Stephen, “so it’s time for these frontline services to be supported to play a central role in encouraging and supporting clients to get tested and treated for hepatitis C.”

Attendees at the recent Penington Institute seminar heard about the importance of NSP workers in supporting their clients to get tested and treated for hepatitis C.

The seminar was attended by frontline staff from organisations including NSPs, hospitals, community health centres, research organisations, government agencies, at home nursing and universities. Speakers included specialist nurse practitioners, a prescribing doctor, an NSP manager, a person with lived experience of hepatitis C, researchers, and staff from Penington Institute. Stephen said that, for the first time, any person living with chronic hepatitis C has the opportunity to be clear of the virus for good – thanks to the introduction of new and highly effective direct acting antiviral treatments.

“People living with hepatitis C who do not currently inject drugs have been a large number of those starting treatment. However, this group – those we might describe as fairly ‘easy to reach and treat’ – will soon be all cured of the virus,” said Stephen.

“Yes, this is a great result, but we are not even close to treating everyone who has hepatitis C if we ignore people who currently inject drugs.”

Bec Thatcher from St Kilda NSP responds to a question to the panel

Around 80 per cent of people acquire hepatitis C by sharing injecting equipment, and new infections occur almost exclusively among people who inject. The Centre for Research Excellence in Injecting Drug Use estimates that approximately 50 per cent of people who currently inject drugs have hepatitis C.

NSPs are the most regular, and sometimes only, contact that people who inject drugs have with a health service.

“We need to be more creative in our response, which means thinking beyond the more traditional medical model to treat people,” said Stephen.

“Investment in the capacity of NSPs to engage their clients in testing and treatment is the only way hepatitis C can be eliminated in Australia.”

“Community health centres, many of which operate NSPs alongside primary health and diagnostic services, are the right venues for developing HCV testing, treatment and prevention pathways.

“We need to better utilise the amazing network of NSPs spread across regional, rural and metropolitan Australia.”

Stephen proposed three activities to achieve this.

“The first thing we need to do is invest in workforce development so NSPs can increase health referrals and provide person-centred support for people who inject drugs to treat hepatitis C.

“Second, we need to develop community-based pathways into testing and treatment. Once people who work in NSPs are empowered to engage people in a conversation about hepatitis C and offer a pathway for their clients, NSPs need to identify the most appropriate setting to deliver testing and treatment interventions, at the local level.

“Community health centres are such a setting: they frequently offer an NSP service alongside medical, diagnostic and sometimes even pharmacy services. If properly supported, they are well placed to utilise their existing service strengths to provide a ‘one stop shop’ experience for current injectors,” he said.

“Thirdly, to maintain the gains delivered by treatment, Australia will also need to increase efforts to prevent hepatitis C reinfection by increasing the baseline investment in NSPs.”

– Sophie Marcard

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