1 April 2019
Hepatitis C (HCV) related morbidity and mortality is on the rise, in 2017, more people were infected than were cured . It is estimated that 71.1 million people are living with chronic HCV infection globally , including an estimated 6.1 million people with recent history of injecting drug use, representing 8.6% of all viremic infections . Following the advent of well-tolerated, simple, short-course direct acting antiviral (DAA) HCV regimens with cure rates >95%, there is potential to reverse the rising burden of advanced liver disease; ambitious new global targets call for a reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by the year 2030.
Effective education programs that increase the capacity of health care practitioners to test for, treat and manage hepatitis C are essential if we are to meet these targets.
Drug and alcohol settings are logical venues for expanding hepatitis C care and treatment, given an existing framework for the provision of care for people who inject drugs. ASHM has partnered with the International Network on Hepatitis and Substance Users (INHSU) and the Kirby Institute at the University of New South Wales (UNSW) to develop and deliver HCV education globally. The Hepatitis C in Primary Care and Drug and Alcohol Settings Education Program provides healthcare practitioners working in drug and alcohol or primary care with the knowledge and skills to expand HCV care beyond hospital settings.
Initially produced by ASHM and the Kirby Institute for the Australian context, this partnership builds on this previous work through collaboration with INHSU and local in-country experts and partners to adapt and translate the program to each local context. Since September 2017, the education program has been rolled out across Canada, Belgium, Spain, the United Kingdom, France, Switzerland and Portugal with upcoming programs in Germany, Sweden and Italy for 2019/2020. To date, 31 workshops have been delivered internationally with 665 participants educated, including 167 general practitioners, 193 nurses and 42 specialists.
Who does The Hepatitis C in Primary Care and Drug and Alcohol Settings Education Program target?
The program generally targets addiction specialists, physicians, general practitioners, nurse practitioners and other clinical staff working in drug and alcohol and primary care settings. In countries where prescribing is limited to specialists, the program seeks to equip auxiliary healthcare professionals with the skills and knowledge to also manage hepatitis C. This is important in enabling effective linkage to care, but also preparing the health workforce for potential removal of prescribing restrictions, as witnessed in Australia, Spain, Belgium and some parts of Canada.
According to Dr. Hemant Shah, Hepatologist from the University Health Network in Toronto, and a member of the Canadian Steering Committee, as we move towards our elimination goals, it is important to engage providers who are enabling access to treatment for the more vulnerable populations, and enable the exchange of innovative ideas between those who are focused on these priority groups. To listen to Dr. Shah discussing the education program in Canada, click on the video below.
The Hepatitis C in Primary Care and Drug and Alcohol Settings Education Program from ASHM on Vimeo.
A global movement towards increasing access to treatment
The timing of this education is pertinent—recent years have seen a global movement towards increasing access to treatment. Spanish Steering Committee member Dr Javier Garcia Samaniego, from the Hospital Universitario La Paz, commended the Spanish system for the removal of treatment restrictions and emphasized the need for universal treatment. The need to enhance micro elimination plans in priority populations was a topic of discussion at the Spanish workshops, as was the importance of increased screening and early diagnosis by a broad range of healthcare professionals, reinforcing the importance of practitioner training in Spain’s HCV elimination efforts. ‘The main challenge for hep C in our country is the design of screening campaigns…General Practitioners and Addiction Specialists have an important role here’ (Javier Samaniego, 2018).
To achieve HCV elimination globally by 2030, future work is particularly needed in regions with impaired DAA access, limited prescribing rights and significant stigma around people who inject drugs. Expansion into these regions will present nuanced challenges to this Project but is imperative in reaching global elimination targets. Drawing on our successes in several international settings thus far, we can continue to adapt our program to effectively reach those in difficult settings and improve health professional’s capacity worldwide.
Photo above: Training facilitator Dr Ed Tam (Vancouver) stands alongside Leslie Gallagher (Vancouver) and Dr Mark Hull (Vancouver) at Hepatitis C in Primary Care and Drug and Alcohol Settings Education Program course. Face-face workshops enable practical and collaborative application of concepts and theory through case discussions, facilitated by experts in the field of hepatitis C.
 Cook, G, Andrieux-Meyer, I, Applegate, T, Aturn, R, Burry, J, Cheinquer et al. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission Available at https://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30270-X/fulltext
 Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, Stone J, et al. (2017). Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review, Lancet Global Health, 5 (12), e1192-e1207.