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Although hepatitis C is a curable virus, just three
per cent of those infected are treated each year
in England, according to a new report from the
Hepatitis C Trust (see news, page 4).
This has led not only to vastly expensive emerg-
ency hospital admissions for potentially avoidable
complications, says
The uncomfortable truth: hepatitis
C in England
, but an almost fourfold increase in deaths
and admissions for hepatitis C-related end-stage liver
disease and liver cancer in the last 15 years.
Around half of the people in England who inject
drugs are infected with hepatitis C and access to
sterile injecting equipment is vital, says the
document, as is ‘treatment as prevention’ – treating
people to reduce the likelihood of future
transmissions. The report also explicitly refutes the
assumption that drug users’ lifestyles are too chaotic
for them to adhere to treatment programmes.
‘That’s not the evidence,’ Hepatitis C Trust chief
executive Charles Gore tells
DDN
. ‘People keep asking
the wrong questions – instead of asking, “can we give
these people treatment?” they should be asking, “how
can we give these people treatment?” If you ask that,
you find a way – it’s really not that difficult. People can
adhere to treatment as long as you arrange it so that
it’s convenient. There are undoubtedly some people
whose lives are too chaotic, but there are people who
aren’t using drugs whose lives are too chaotic – in the
middle of an incredibly messy divorce, say. It should
be assessed in exactly the same way.’
One major problem is the huge variations in
service provision – and waiting lists – across the
country, he points out, alongside variations in who will
actually treat drug users, ‘or indeed substance users –
I heard in the last few days about somewhere where
they were insisting on people being abstinent from
alcohol for six months before treatment, which is
ridiculous,’ he says. ‘In other parts of the country
people are very unconcerned about that – it’s “are you
ready for treatment, can we support you properly?”’
The trust published a report earlier this year that
said local authorities weren’t ready to take
responsibility for hepatitis C, with only a quarter
actually having any figures on how many people
were infected in their area (
DDN
, April, page 5). Has
there been any improvement on that front? ‘We
haven’t done a follow-up yet, but anecdotally I’m not
at all sure that they’ve completely got their heads
around public health,’ he states. ‘On a more positive
note, I do think that Public Health England are
definitely getting themselves in order and they do
seem to understand that hepatitis C needs to be a
priority – they’re certainly looking to really improve
things in prisons, for example.’
When it comes to drug services, the report calls on
them to establish peer support programmes and
encourage testing, among other measures – does he
think that hepatitis C is enough of a priority for them?
‘No, and too many make assumptions about people’s
readiness and priorities. Everyone they come into
contact with should be tested for hepatitis C. Then
they should be referred, and it’s not up to a drugs
worker to take a decision about somebody’s
readiness – and more importantly, their need – for
treatment. How do you know they don’t have
cirrhosis? It’s not enough to say “they’ve got other
priorities” – their priorities might change if they’re told,
“if you don’t do treatment now you’re not going to be
able to do it, and you’re going to be looking at a liver
transplant”. It’s about testing, then it’s about referral,
then it’s about supporting people into referral.’
Given that many people with a substance use
history have not always ‘been treated so fantastically
well’ in hospital they may not necessarily be inclined
to go, he says, and may need motivational help. ‘But
it’s not about forcing them onto very difficult
treatment – it’s about assessing them and giving
them choices. They’re not going to be forced to
have a biopsy, which is another fear people have. It’s
about making sure they’re in the system so if they
need to do treatment they have the option, and if
they don’t they can do it a point that’s good for
them. Given that we’re moving to this era of much
easier drugs for a much shorter duration, it would be
sad if they didn’t have that option.’
It’s also vital that the right information gets out to
drug users, he stresses, and the message is a
simple one. ‘The first thing is, it’s really important to
get tested, because if you’re negative you can be
given the information about how to stay negative.
Very often people think they’re infected, whereas 50
per cent of injecting drug users don’t have it, so you
might well be in the 50 per cent who don’t, and you
can avoid it. If you’re positive, it’s about how not to
transmit it and that there’s treatment available, so
you can get rid of it.
‘Just because you’re using drugs doesn’t mean
you don’t have a right to treatment, and the trust is
there to fight for people if they come across snooty
hepatologists who say “no, you’re too difficult”. You
have the right to treatment. And it’ll cure it.’
The uncomfortable truth at www.hepctrust.org.uk
A new report is calling for hepatitis C to be prioritised as a major health inequalities
issue by Public Health England, the NHS and local authorities.
DDN
reports
News focus |
Analysis
WHY ISN’T MORE BEING
DONE TO TACKLE HEP C?
6 |
drinkanddrugsnews
| November 2013
www.drinkanddrugsnews.com
‘Just because you’re
using drugs doesn’t
mean you don’t have
a right to treatment.’
CHARLES GORE,
HEPATITIS C TRUST