Blood Borne Viruses Flashcards
What are examples of BBV?
- HIV
- HEP B
- HEP C
What are some issues faced by people living with hepatitis C?
- 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
Can Hepatitis C be cured?
Yes, easily, with direct-acting antiviral (DAA) medications
What happens in the liver because of Hepatitis C?
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
91% of NEWHep C infections are the result of people …?
Sharing their drug injecting equipment?
Why are Hep C levels are so high?
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
How much HEP C in:
A) general community
B) adult male prisons
A) 1%
B) 33%
What is the mission of the national drug strategy?
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
What are the three factors to harm minimisation in the national drug strategy
- Supply reduction –> legislation, border patrols
- Demand reduction –> detox/rehab, school education
- Harm reduction –> NSP (needle syring program), opioid replacement programs
What are needle syringe programs (NSP)? What does it provide access to?
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
Is NSP legal?
NSP is legal – the WA Poisons Amendment Act (1994) allows approved organisations to provide sterile injecting equipment to people who use drugs
More non-aboroginals than aboroginals use NSP, true or false
True
How do pharmacy staff enhance service delivery for NSP and thus require NSP education?
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
Information about HEP C…
- 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
What are some factors that lead to getting hepatitis C?
- 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
What are the latest HEP C treatments? Give four answers.
- Epclusa - 12 weeks (all genotypes)
- Harvoni - 8 or 12 weeks (for genotype 1)
- Maviret - 8 weeks (all genotypes )
- Zepatier - 12 weeks (for genotype 1 and 4)
What are the side effects with DAA treatment?
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
What is some of the criteria for DAA treatment?
- 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
Who is eligible to prescribe DAAs?
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
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?
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
What are some barriers for access to DAA?
- 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
What is the HepatitisWA treatment clinic?
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
What are some harms of injecting drugs besides HEP C?
- Vein damage and collapse
- Tracks and bruising
- Abscess
- Cellulitis
- Embolism
- Endocarditis
- Fungal infections
- Septicaemia
- Thrombosis
Why filter drugs?
- 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
What does the pharmacy registration board of WA hold blanket approval from? What is thee no approval needed for?
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
Profile of pharmacy NSP client differ to NSEP (needle and syringe exchange program). How so?
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
What are barriers to accessing pharmacy NSP?
Time – limited open hrs •
Cost •
Fear of exposure •
Lack / breaches in confidentiality •
Lack of information/education resources •
Negative/discriminatory attitudes of providers
NSP have prevented thousands of cases of HIV and hepatitis C infection.
True or false
True duhh
Can provide NSP to minors?
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’
Provision of NSP to pregnant women? What factors to think of?
HIV, hepatitis B and hepatitis C can all be transmitted from mother to baby during pregnancy or birth
remember pharmacies can
