ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

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So good to hear about new studies in HIV/HCV co infections.

Patietns have waited or so long for better outcomes of treatment and although the new DAAs come with precautions and drug interations when combining ART with DAAs, they offer better treatment outcomes than seen previously.

Looking forward to offer new treatment options and the challenges before us in treating HIV/HCV coinfetions.


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Early Monday morning, New Zealand TV viewers woke up to Dr Ben Cowie, highlighting the importance of hepatitis B testing. 

Ben was interviewed on New Zealand national station, TV3. The interview provided an opportunity to flag the Auckland Statement, which calls for urgent action to prevent new infections and stop the rising death toll caused by both HCV & HBV. 

View Dr Ben Cowie's interview, read the press releases relating to his presentations at the Conference, and sign the Auckland Statement

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We first met Yvonne Drazic at the 2010 Viral Hepatitis conference, where she bravely presented her personal story of living with chronic hepatitis B.

It's wonderful to see Yvonne back again, now presenting on her current HBV research project (for which she's received an ASHM Junior Researcher Award). Yvonne's personal experience has been a major driver in her efforts to improve HBV awareness and care in primary care.

Yvonne's research project is an exploration of current awareness and practice in primary care in north QLD. Whilst recruitment of GPs into the project has proved a challenge (with Yvonne trying every trick in the book), initial results have shown we have a long way to go. Less than 50% of GPs surveyed would test Asian migrants for HBV and less than 30% would test Aboriginal and Torres Strait Islander patients. When asked about their preference for education, the most preferred option was evening dinner updates with a surprisingly lack of appeal for videos...

Congratulations Yvonne - we look forward to hearing more.

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Tracey Cabrie, hep B CNC, presented this morning on the Integrated Hepatitis B Service, a pilot program based at the Royal Melbourne Hospital.

The program was set up with funding from the Department of Health Victoria, received following significant advocacy work from General Practice Victoria (GPV) and others in the sector.

There are 2 hepatitis B CNCs working part time in the role (0.6 FTE in total) to build capacity and support GPs in high prevalence areas of
Melbourne, to care for patients with chronic hepatitis B. The GPs/clinics collaborating in the pilot have high caseloads and are keen to be involved. A parallel ground swell of hepatitis B education is also providing primary care, more broadly, with the skills to upscale management and care.

For more information, contact This email address is being protected from spambots. You need JavaScript enabled to view it. .

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The Australian Hepatology Association has launched their consensus based guidelines for hepatology nurses.

What an achievement to gain consensus!

This will be a fantastic tool for nurses working in the field now and those starting out in hepatology.

The guidelines will be available for download next week at

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Jac Clegg from Justice Health NSW presented today on the nurse-led model of care for hepatitis C – a safe and effective model for hep C assessment, management and treatment. The nurse-led model of care is led by clinical nurse consultants who use protocols to assess and triage patients.

The role of these CNCs also includes treatment education, initiation, monitoring of adverse effects and follow-up post treatment. Evaluation of the pilot has shown that there is a strong correlation between the triage category determined by CNCs and specialists, indicating nurses are appropriately triaging patients.

What would be the barriers to implementing a similar model in other settings, for example rural/remote environments?

Would other States/Territories establish a similar model in their prison systems?

I hope this successful pilot in NSW fuels the discussion of rolling out nurse-led models of care.


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They're dedicated, they care and they need help!

The reports from Cambodia, Indonesia, Lao, Sri Lanka, Thailand and Vietnam all told similar sad stories - high numbers of HBV/HCV and low priority response from government.

Patients on incomes less than US$1,000 expected to pay US$14,000 for treatment!

Despite the odds, these doctors have in the past 12mths introduced new programs and are constantly advocating for greater recognition and increased funding to prevent the rise of viral hep.

Their stories may have been sad, but their drive and positive attitudes were inspiring. 

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Dr Josh Davis stated in his presentation today that a funded HCC surveillance program is urgently needed for the Northern Territory. HCC incidence is much higher in the Northern Territory than the Nationally and there are significantly higher rates amongst the Aboriginal and Torres Strait Islander population (six-fold).

His study findings showed that the majority of Aboriginal and Torres Strait Islander people present when symptomatic and because of this late presentation palliation was the only form of treatment for 53% of these patients. 

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AIVL has found a novel approach to engage the Indigenous population of Australia.

The project, Dulangirr Gubbynidgel (New Beginnings) have released a Hepatitis C peer education kit, develolped by Aboriginal people who use illicit drugs, some of whom have HepC and those at risk.

Included in the kit are games, exercises and information.

The message is in the name, HepC isn't necessarily 'the end', but could be an opportunity to make changes and get people thinking about their health and to "start looking after themselves"

The Transmission Risks Game asks players to place cards where they believe they should go.                                                                                       Is the behaviour/activity:                             

HIGH RISK?                                                                                                                                                                                                        MEDIUM TO LOW RISK?                                                                                                                                                                                        VERY LOW RISK?                                                                                                                                                                                         EXTREMELY LOW RISK?                                                                                                                                                                                      NO RISK?

Aimee Capper reports that the knowledge gained has reduced the amount of bed linen going up in flames, as the card game showed that sheets were a 'no risk' route of transmission!


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Just attended a session on treating HCV in Tasmanian Prisons where they are experiencing higher than expected treatment response rates for GT 1 with a team of GPs, a BBV specialist nurse and telehealth across 8 sites. 

Numbers of patients treated have steadily increased in the 5 years the program has been runing and they now treat three times the amount of patients than they started with- fantastic!!

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Ben Cowie, ID physician at the Royal Melbourne Hospital and Epidemiologist at the WHO Regional Reference Laboratory for Hepatitis B, Victorian
Infectious Diseases Reference Laboratory, presented a thought provoking session yesterday on actively linking epidemiology with public health policy and resourcing.

Ben explained that we have a responsibility to make the surveillance systems work for the individuals the surveillance system is capturing data on. He
advocated for using surveillance systems to deliver health outcomes, not just measure them.

Seems like a very logical message – so why don’t we do this automatically?

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The day started with a traditional Maori opening followed by presentations from key speakers then, the moment we have been waiting for- the launch of the AHA Consensus Based Nursing Guidelines. Dr Jaqui Richmond will present more on the development of the guidelines tomorrow at 11am.

As anticipated, my favourite sessions of the day were on the outcomes of horizontally acquired CHBV in the Maori population, hearing about the Kawerau Study and treating CHBV in remote dwelling aboriginal patients in the Northern Territory.

Then, tonight finished  with presentations on the new protease inhibitors for HCV triple therapy.

Tomorrow promises to be another full day starting with the breakfast symposium followed by international speakers in the next session and then I spy presentations on HCC in the NT, treatment outcomes for prisoners with HCV G/T 1 and nurse led follow up of patients with cirrhosis.

'Nite all.





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Despite the cracks caused by the 2010 earthquake, the Christchurch HepC Community Clinic continued to operate. Then came 2011 and it all came tumbling down – literally.

BUT the Clinic continued to operate, moving first to Receptionist Mickey’s home, then a Portaroom and then to an industrial area.

The Clinic became a lifeline, providing vital and practical support to their clients.

The earth may have separated, but not the clinic and their clients.

Today, they have a new and stable home and play a major role in the provision of HepC care and are a shining example of what can be achieved against the odds.

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I was inspired by Jacqueline Clegg's report on the nurse-led outreach program for assessment and treatment of chronic hepatitis C via telemedicine in the prison setting. She told of the success of the program in which assessment for treatment was done using Clinical Nurse Consultants as the key providers providing decentralised care with specialist back up via telemedicine.

The pilot program was a success and the model was shown to be both effective and safe. It would be good to see application of this model in rural and remote settings for hepatitis B. Jacqueline said that this may be in the pipeline for a future pilot, I look forward to hearing more.

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Kelly Barclay told us that unlike Australia, there are a large number of undetected HCV sufferers in the NZ community, so the decision was made not to wait, but to 'take it out there'.

In an 18mth pilot program a Community Nurse will provide assessments, fibroscans, education and discuss treatment options in 2 pilot sites.

This pilot will potentially remove one of the major barriers to addressing HCV, as the nurse will be located in the Community thereby increasing the number of access points to information and or treatment.

It's hoped that the opportunity to access information and support will result in earlier lifestyle changes and increased uptake rates in monitoring and or treatment.

Sounds like a positive approach and we look forward to hearing about it's success rate.

Well done Kiwis!

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Anyone know what's stopping us from having a national hepatitis B related HCC surveillance program across Australia?

New Zealand has had a program since 2003. Surveillance increases survival for people living with chronic hepatitis B, but is the first step a national screening program?

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Professor Henry Chan gave a comprehensive overview of the of HBV in the Asia Pacific in the opening plenary this morning. Professor Chan began by by making the point that hepatitis B virus (HBV) has been around for over 40 years and still presents a significant health burden for the Asia-Pacific region. HBV is the most common cause of liver cancer in Asia. In some countries, over 80% of hepatocellular carcinoma (HCC) is caused by HBV.

He outlined that vaccination for HBV has made a difference, using Taiwan as an excellent example where prevalence of HBV in children has dropped dramatically to as low as 0.19 per 100,0000 in 2007, since the introduction of universal vaccination in 1984. However, achieving adequate coverage is still a challenge for many countries in the region.

There are also challenges regarding the treatment of hepatitis B. There are effective treatments available, however cost and access to the best first line therapies often presents a problem, particularly in resource- poor settings. This can lead to further challenges regarding resistance (following the use of older drugs such as  lamivudine).   Professor Chan presented evidence for the need for continuous long term therapy for  hepatitis B and how this presents challenges in all settings.

Following 40 years of hepatitis B, there is still much work to be done and challenges to be overcome to ensure the health burden of hepatitis B is reduced in the Asia Pacific region.

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"I have problems trusting people because I've been screwed over so many times".

Professor Paul Ward from Flinders University reminded us today of the centrality of trust to people with viral hepatitis accessing health services and adherence to treatment.

There are two levels of trust: personal and systems-based, so trust is not just about the behaviour of the health worker. The health service itself has to place the patient at the centre of its model of care, so that the individual can find a "safe passage" through.

To me, it comes down to acting with integrity and consistency. Do what you say you're going to do.

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Prof Paul Ward asked if 'trust' was an integral part of our practice and if we had considered the impact on treatment outcomes for our patients. He graphically (with humourous dipictions) described the differing perceptions of a variety of cohorts, including CALD, MSM, Sex Workers and Indigenous patients and how trust is essential to ensure adherence to care plans.

There are many different concepts of trust, but essentially the need to trust is due to lack of knowledge i.e. you have to rely on the clinician, and in trusting there is an element of risk, as you have to assume the clinician has the level of appropriate knowledge and also has your best interests at heart.

There also needs to be trust in the system and for a patient this trust is usually formed at the point of access, therefore, the person who has initial contact can influence the level of trust - begs the question, are we providing an appropriate level of training for our frontline staff?

For a patient, once a trusting relationship has been formed, they can 'move on' and concentrate on their journey and not on the driver.

Fortuitously, a survey has shown that 62% of the Australian population trust their doctors, but only 2.2% trust their politician.

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