• Fantastic First Ever Australian Hepatitis C in General Practice Forum held in Adelaide 2018

    It is now nearly three months since the first national 'Treating Hepatitis C in General Practice Forum' was held in Adelaide. I was lucky enough to be a member of the organising committee which included GPs from across Australia. 

     On reflection, highlights from the day-long event included: 

    • Having 50 GPs from across Australia in a room, with a mix of experience from novice to experienced HCV prescriber, to share information and experiences. It was great having a few HCV specialists in the room providing the latest information and evidence. The feedback from the day was so positive that we are hoping it will become an annual event.  

    • The important role GPs can play in the whole person viral hepatitis disease management, from detecting the 30-40,000 people living with chronic HCV not yet diagnosed, to one stop shop GP HCV assessment and DAA treatment for most, and the important long term role monitoring of those with cirrhosis. 

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  • Applying the 8 Ways to Increase Hepatitis C Treatment in my Practice

    I am a general practice registrar in Launceston, Tasmania. Attending the Treating Hepatitis C in General Practice Forum was a great educational experience for me. I was able to appreciate the practical intricacies of treating Hepatitis C in the community, and learn from passionate general practitioners from various parts of Australia about treating Hepatitis C.  

    I learnt the most from Dr Nada Andric’s presentation about the 8 ways to increase HCV treatment in general practice. She illustrated the 8 steps to take, including audit, training, bloods, GPMP, connect, pharmacy and follow up. They were practical methods and easily translated to my practice in Launceston. Since attending the Forum I have prepared a plan according to the 8 steps: 

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  • Changing our approach to service provision for Culturally and Linguistically Diverse Groups

    A report on the Opening Plenary, delivered by Associate Professor Leonie Pihama, Professor Matthew Golden, and Associate Professor Carmen Logie.

    In this plenary, three presenters from three countries discussed how to make approaches to HIV and other STI programs workk in specific populations.

    Key learnings:

    Whilst didactic approaches to populations with good levels of literacy might be effective in certain circumstances, many other groups require different approaches. Hard to reach populations require innovation and dedication and may be far more labour intensive to ensure enrolment in, and maintainance of, programs. Programs that have failed to attract certain clients will continue to fail to attract these clients. What is needed is a different program and not a repetition of the existing program. 

    Developing understandings of diverse cultural groups can ensure that Practitioners can gain trust with their patients, which can help empower them to make decisions that impact their health positively. Aspects to be considered range from communication methods, including availability to care in their own language and the physical materials used, to practical logistic considerations such as provision of transport to access testing or treatment. Services may need to be free or nearly free and there must be consideration about longer-term sustainability.  

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  • The power of education in ensuring equitable access

    A report on Dr Richelle Douglas’ presentation “Abortion: empowering the clinical workforce” 

    This symposium explored equity of access to contraception and abortion, with Dr Douglas providing a clear voice in not only explaining what some of the issues are, but also what can be done to overcome them.  She discussed access and uptake of abortion globally, attitudes to abortion, implications of training and how we can begin to improve.  My main takeaway was that access to abortion training is limited, which has serious implications for our patients. 

    Half of all pregnancies are unintended and 1 in 4 women have a termination of pregnancy (TOP) at some time in their lives.  Unintended pregnancies have a higher risk of maternal morbidity and mortality. Therefore improving access to contraception and abortion can improve maternal mortality rates.  In general, these facts are not debated, but what is less straightforward is how to overcome this problem. In Australia there are limited public facilities that provide abortion training and services.  This results in massive inequity of access, with the most vulnerable people in our community often unable to pay for and access a TOP. 

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  • Future Contraceptive Options

    A report on Deborah Bateson’s presentation “ASHA Oration – Distinguished Services Awardee Presentation” 

    This presentation outlined some very innovative contraceptive options that may be used soon. Examples are smaller IUD’s for smaller women; self-injected sub-cutaneous Depo; male contraception; and a microchip that lasts for 16 years and can be turned on and off depending on fertility desires!  

    Another interesting potentiality is a monthly pill taken towards the end of the menstrual cycle that has different actions dependent on the whether the woman is pregnant or not. If the woman is not pregnant then she would have a normal monthly period, however if she is pregnant then this pill would terminate the pregnancy at the very early stage, even before a woman is aware that she is pregnant. These contraceptives are not yet approved for use in Australia and some will likely meet many obstacles to becoming available.

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  • Addressing Adolescents on ARVs

    A report on Caroline Foster’s presentation “Adolescent lives matter: Staying with it - novel ways to increase adolescent adherence” 

    In this presentation Caroline, who works at the 900 Youth Clinic at St Mary’s Hospital London, spoke specifically about the challenges around adherence with HIV-positive young people aged 16-24 who are either newly diagnosed or transitioning from children’s services.  

    One of my key learnings from this session is that poor adherence in adolescents is normal, with poor adherence in those on ARVs at around 20% in London. Adherence patterns are also similar across disease types. For example, this pattern of reduced adherence in PLWH around puberty and the teenage years is equally matched with those living with Type 1 Diabetes Mellitus, corroborated by reduced glucose control during such years. 

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  • Co-infected HIV/HCV with Multiple DDIs

    A report on Erica Peter's presentation "Interactive Case Study: HIV-HCV and PWIDS"

    Dr Erica Peters, a local Glasgow ID physician, has seen a disturbing rise in the incidence of HIV (133 in the last few years, 1/3 women) in the population of people who inject drugs in Glasgow: many are co-infected with HCV. This population poses challenges for decision-making on drug therapy given that many people in this population are both taking both prescribed and recreational drugs.

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  • One more reason to be PrEPed: it’s safe!

    A report on Victoria Pilkington's "Meta-analysis of the risk of Grade 3/4 or serious adverse events in 12 randomised trials of PrEP (n=15,678)"

    Since its presention at HIV Glasgow, there has been a lot of coverage of the meta-analysis of PrEP presented by Dr Victoria Pilkington of Imperial College, London (e.g. ow.ly/ALap30mppiv). The story has been re-told through a variety of medical and non-medical media emphasising the bottom line: TDF/FTC as PrEP is safe. As we know, there are an increasing number of PrEP prescriptions in North America, Australia, and Western Europe with the global estimated number of people taking PrEP to be around 300 000.

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  • Price gouging by pharmaceutical companies for HCV medications impacts on the world’s ability to meet elimination targets

    A report on Andrew Hill's presentation "Minimum prices of generic Hepatitis C direct acting antivirals fall below US$50"

    Andrew outlines an alternative cost strategy for making the elimination of Hepatitis C (HCV) affordable. This talk complements the previous one by Margaret Hellard.

     

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  • Eliminating Hep C by 2030: How are we going and what else is needed?

    A report on Margaret Hellard's "Eliminating Hepatitis C by 2030: A public health perspective"

    Margaret made a compelling case for a more concerted effort to be made worldwide for Hepatitis C ( HCV) to be eliminated. HCV is responsible for a similar number of deaths worldwide as HIV and TB, and more than are due to malaria. Yet, HCV is remarkable for now having a highly effective cure using Direct Acting Antivirals (DAAs), that can be achieved in 3 months and with minimal side effects.

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