Key Points from Day 2 – Point of Care Testing, Hepatitis in Prisons, Indigenous and Immigrant Populations

(A report back on the Australasian Viral Hepatitis Conference Day 2)

Globally there is a move to developing point of care testing (POCT), with the aim to test and treat on the same day. New developments include an instant Hep B e-ag and ALT semi quantitive disposable diagnostic device, the combination of these positive results having an 80% correlation with more thorough investigations with hep B Viral Load, fibroscan and full bloods. Local TGA restrictions prevent the use of POCT currently.

There was a long session on local prison experience and barriers to treatments. There was universal cry for needle and syringe programs (NSP) in prisons, to decrease reinfection, Canada is trialling a NSP in prisons. There was frustration about the lack of aftercare and follow up of released prisoners but noting that 44% would be reincarcerated. 

Locally in south western Victoria there was a presentation about trying to support GPs to prescribe hep B and C drugs, with an assessment page that can be integrated into Medical Director and others and reviewed by an ID physician with the idea of supporting and overseeing low caseload GPs managing viral hepatitis. 

Of course, the indigenous population fall behind in vaccination rates and there is evidence of less vaccine efficiency in this group for reasons unknown. There has been break through hepatitis B in previously vaccinated ATSIG.

Locally it is estimated that we have diagnosed 60% of the hep B burden and we are treating 6%. We need to get to the WHO target of 80% diagnosed, and 15% treated in order to be effective in lowering the negative outcomes. 

There are still too many late diagnoses of hep B and this is racially distributed. eg Vietnamese in Australia are 9X more likely to suffer serious and potentially preventable poor hep B outcomes. The Chinese immigrants are an emerging group who has the greatest growth of hep B It is becoming increasingly difficult to get a permanent Visa for immigrants with hep C, and doctors are increasingly called upon to write reports that may facilitate this. ASHM and Hepatitis Victoria have some resources and pro forma letters. 



Author bio: 

I am a sexual health physician working at The Centre Clinic and Melbourne Sexual Health Centre. I am a Hepatitis B s100 prescriber and have a high HIV caseload. I also work as a General Practitioner.