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PP5 Lectures (Bal) > Blood Borne Viruses > Flashcards

Blood Borne Viruses Flashcards

1
Q

What are examples of BBV?

A
  • HIV
  • HEP B
  • HEP C
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2
Q

What are some issues faced by people living with hepatitis C?

A
  • Historically very poor treatment options •
  • Issue often misunderstood, and subject to fear, stigma, and discrimination •
  • Facing an uncertain future •
  • Often unaware of status due to silent nature and lack of screening opportunities •
  • The physical impacts of advancing liver disease
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3
Q

Can Hepatitis C be cured?

A

Yes, easily, with direct-acting antiviral (DAA) medications

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4
Q

What happens in the liver because of Hepatitis C?

A

Cirrhosis

  • without intervention –> 175% increase in the number of people with compensated cirrhosis and 190% increase in decompensated cirrhosis
  • 190% increase in all cirrhosis by 2030

Liver cancer

  • without major increase in treatment access, number of people with primary liver cancer due to hepatitis C is expected to rise.
  • 245% increase in liver cancer by 2030

> 230% increase in liver-related deaths by 2030

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5
Q

91% of NEWHep C infections are the result of people …?

A

Sharing their drug injecting equipment?

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6
Q

Why are Hep C levels are so high?

A

HCV levels amongst IDU’s (injecting drug users)

Efficiency of syringes at passing on blood •

HCV transmitted through other injecting equipment •

Resiliency of the HCV •

Lack in the availability of sterile injecting equipment •

Current circumstances of PWID (people who inject drugs)

Lack of education

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7
Q

How much HEP C in:

A) general community

B) adult male prisons

A

A) 1%

B) 33%

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8
Q

What is the mission of the national drug strategy?

A

An overall policy statement which aims to:

  • Build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals, families and communities
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9
Q

What are the three factors to harm minimisation in the national drug strategy

A
  1. Supply reduction –> legislation, border patrols
  2. Demand reduction –> detox/rehab, school education
  3. Harm reduction –> NSP (needle syring program), opioid replacement programs
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10
Q

What are needle syringe programs (NSP)? What does it provide access to?

A

NSP provide access to sterile injecting equipment

provides access to

  • Other safer injecting equipment (including swabs, filters, spoons, ampoules of water, tourniquets)
  • Disposal, collection and exchange services
  • Education and health information
  • Primary medical care
  • Referral to other medical, legal, social and treatment services

> we have one of the lowest rates of HIV in the world and this is largely due to the early implementation of NSP (australia) –> only 1% new HIV from IDU

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11
Q

Is NSP legal?

A

NSP is legal – the WA Poisons Amendment Act (1994) allows approved organisations to provide sterile injecting equipment to people who use drugs

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12
Q

More non-aboroginals than aboroginals use NSP, true or false

A

True

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13
Q

How do pharmacy staff enhance service delivery for NSP and thus require NSP education?

A

Pharmacies are often the first point of contact for credible health information

Enhance service delivery by:

  • Increase the awareness of Blood Borne Viruses (BBV’s)
  • Increasing awareness & knowledge in relation to drug use and drug related harm.
  • Maximise opportunities for harm reduction
  • Improve referral pathways to specialist care
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14
Q

Information about HEP C…

A
  • Only transmitted from blood!
  • Approximately 25% of people clear naturally

> no immunity and reinfection possible

  • Only 20% experience initial acute symptoms

> most likely is a mild flu illness

  • Time frame for cirrhosis 15 to 30 years
  • Acute symptoms (20% people experience acute symptoms)

> flu like symptoms = nausea, lethargy, malaiase, abdominal pain and jaundice (<5%)

death is the least likely outcome of a viral hepatitis infection

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15
Q

What are some factors that lead to getting hepatitis C?

A
  • Sharing injecting equipment
  • Cleaning techniques can be ineffective
  • Non injecting drug equipment
  • Unsterile tattooing and body piercing
  • Sharing personal hygiene items
  • Sport/Violence
  • Other risk behaviours such as self-harming
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16
Q

What are the latest HEP C treatments? Give four answers.

A
  1. Epclusa - 12 weeks (all genotypes)
  2. Harvoni - 8 or 12 weeks (for genotype 1)
  3. Maviret - 8 weeks (all genotypes )
  4. Zepatier - 12 weeks (for genotype 1 and 4)
17
Q

What are the side effects with DAA treatment?

A

Most of the DAA treatment is well tolerated with mild side effect in some patients

Most commonly reported side effects include

  • • Fatigue • Joint pain • Headache • Nausea/diarrhea • Insomnia
18
Q

What is some of the criteria for DAA treatment?

A
  • Patients must be over 18
  • Patients require two confirmed positive tests with no less than 6 months between tests (for newly acquired HCV)
  • Patients will have blood tests and possibly scans to confirm genotype, viral load, and degree of liver damage
  • Patients can not be pregnant or breast feeding
  • Patients must have a valid Medicare card (or be eligible)

Current drug and alcohol use, whilst not encouraged, does NOT exclude someone from treatment access

19
Q

Who is eligible to prescribe DAAs?

A

Medical practitioners including GP’s and nurse practitioners that have experience in hepatitis C treatments

  • Those without experience can still prescribe by consulting with above specialists to gain experience.

Specialist care referral is not usually required unless patients are complex

20
Q

If a DAA script is written by a GP, it can be dispensed at a? What is the price per month for general and concessesional patients?

A

community pharmacy

  • $41.30 per month for general patients and $6.60 per month for concessional patients
  • Free under the CTG for Aboriginal and Torres Strait Patients

> Not all pharmacies are currently willing to stock medications - list accessible pharmacies on our website

21
Q

What are some barriers for access to DAA?

A
  • Belief that drug and alcohol consumption will make someone ineligible for treatment
  • Belief that treatments are too expensive
  • Belief that the side effects are extreme and invasive
  • Belief that it is necessary to navigate through liver clinics for treatment
  • Belief that accessing hepatitis C treatments will label a person as an injecting drug user
  • Previous negative experiences at engaging with primary health around hepatitis C
  • Hierarchy of needs – willingness to adhere
22
Q

What is the HepatitisWA treatment clinic?

A

Community based access to hepatitis C treatment services

  • Preference for clients to access current GP
  • Primarily aimed at current injecting drug users
  • Comorbidity issues/cirrhosis not necessarily a barrier
  • Clinic will operate for ½ day (Tuesday or Wednesday) on weekly basis – no referral needed but appointment essential
23
Q

What are some harms of injecting drugs besides HEP C?

A
  • Vein damage and collapse
  • Tracks and bruising
  • Abscess
  • Cellulitis
  • Embolism
  • Endocarditis
  • Fungal infections
  • Septicaemia
  • Thrombosis
24
Q

Why filter drugs?

A
  • Drugs are not made or store in controlled conditions – bacteria
  • Removing insoluble particles
  • Removing ingredients designed for oral consumption
  • Removing microbes on skin, air, and surfaces
  • FILTERING DOES NOT IMPACT BBV’S
25
Q

What does the pharmacy registration board of WA hold blanket approval from? What is thee no approval needed for?

A

PRBWA holds banket approval from all WA pharmacies to provide fitpacks, fitpack plus, fitsticks, and sterafit kits

DOH approval required for singles and other packs

No approval needed for:

  • Sterile water
  • Swabs
  • Filters
  • Tourniquets
26
Q

Profile of pharmacy NSP client differ to NSEP (needle and syringe exchange program). How so?

A

Younger (mean 32.4 years) •

Shorter injecting history (mean 12 years) •

Inject less frequently (38.4% daily) •

Most commonly inject meth/amphetamine

Pharmacy recruited IDU appear to be considerably more disengaged from BBV and drug-related health services than those recruited from NSEP

  • 70.1% access sterile equipment exclusively from Pharmacy NSP & 55% visit less than weekly
  • 83.5% reported they did NOT know of other places to access sterile equipment
27
Q

What are barriers to accessing pharmacy NSP?

A

Time – limited open hrs •

Cost •

Fear of exposure •

Lack / breaches in confidentiality •

Lack of information/education resources •

Negative/discriminatory attitudes of providers

28
Q

NSP have prevented thousands of cases of HIV and hepatitis C infection.

True or false

A

True duhh

29
Q

Can provide NSP to minors?

A

In WA there is no law denying the sale of injecting equipment to minors

The Poisons Amendment Act (1994) refers to NSP clients only as ‘person’

30
Q

Provision of NSP to pregnant women? What factors to think of?

A

HIV, hepatitis B and hepatitis C can all be transmitted from mother to baby during pregnancy or birth

31
Q

remember pharmacies can

A

PP5 Lectures (Bal) (19 decks)

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