Novel HCV harm reductions approaches in Australia

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Novel HCV harm reductions approaches in Australia

• Levinia Crooks
• Chief Executive Officer
• Australasian Society for HIV Medicine Australia

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Approaches

• Needle and syringe programs
• Community pharmacy
• Leadership
• Pharmacotherapy
• Prison settings
• Supervised injecting
• Targeted education programs
• Leadership, political support policy

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Needle syringe programs

• Initiated in 1986 by Alex Wodak
• St. Vincents Hospital Sydney
• The harm associated with injecting using a
  contaminated needle and syringe outweighed to
  harm of providing clean needles to people who
  inject

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NSP practicalities

• Primary NSP are facilities designed for NSP as
  their main purpose
• Secondary NSP are facilities which distribute
  needles and syringes and include hospital
  emergency departments, community health other
  community agencies
• Community pharmacy is the distribution (usually
  sale) of needles and syringes via chemist shops
  in the community

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Problems and solutions for NSP

• Location not near schools or churches, also
  mobile vans and vending machines
• Fit-packs used for the safe disposal of used
  equipment
• Needles in the street clean-up hotlines to
  facilitate quick removal of used equipment
• Potential for harassment - liaison with local
  police
• Distance from government reduce questions and
  media interest

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Brief prevention strategies

• Training of NSP staff, particularly secondary
  outlet staff to provide information to clients
• Postcards and other discrete prevention
  materialspackaged with fit-packs

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NSP worker training kit topics

• Alcohol and Other Drugs
• Minimising the Harm of
• Injecting drug use
• Getting the Right Fit
• Looking at Attitudes Values
• Looking after Ourselves
• A Tough Call
• Advocacy in NSP
• Sex n Drugs

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Community pharmacy

• Community pharmacy has played a large role in the
  distribution of clean injecting equipment
• More recently there has been considerable
  planning in place to look at furthering the role
  of community pharmacy in an HCV treatment
  awareness campaign.

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High level leadership

• Policy and other advisory groups kept abreast of
  program and prepared to support program if under
  threat
• Ongoing attempts to reinforce the idea that the
  harm associated with spread of infection is what
  needs to be reduced and this (harm) needs to be
  removed from the health issue of drug use,
  particularly among young people and people
  experimenting with drug use

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Detailed information provided regularly to senior
advisors
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Excerpt from NSW Parliament

• NSW Health has a public health obligation to
  provide these services. Federal and State
  governments across Australia support the
  provision of needle and syringe programs, as do
  the chairpersons of the HIV and Hepatitis C
  Advisory Councils, Dr Roger Garcia and Professor
  Geoff McCaughan. Since 1986, needle syringe
  programs have prevented an epidemic of HIV among
  Australian drug users. In Australia less than 2
  per cent of drug users are infected, compared
  with far higher ratessome as high as 30 or 40
  per centin most other countries in Europe, Asia
  and America. At the same time, it has been shown
  that needle and syringe programs do not lead to
  higher rates of drug use, nor do they interfere
  with the work of police.
• John Della Bosca 25 May 2005

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Treatment in drug alcohol settings

• While treatment per se as a prevention strategy
  is a long way off, optimising opportunities to
  engage with treatment is feasible.
• ASHM along with a number of state governments and
  researchers are making training available to AOD
  and pharmacotherapy centre to maximise their
  capacity to provide education and treatment.

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Methadone buprenorphine

• Pharmacotherapies are available in the community
  and dispensed in the community via community
  pharmacies
• Increase in places not sufficient to meet demand
• Limited pharmacotherapy for amphetamines and not
  in any regular usage

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Prisons as treatment opportunities

• Australia has been very slow in developing a
  national policy on HCV prevention in prisons.
  This is largely a result of an HIV transmission
  from inmate to prison officer in 1990 which let
  to the derailing ofprevention efforts

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Populations in prison

• Aboriginal Australians are vastly over
  represented in prisons 2 of population and 20
  - 80 of prison populations
• Women are often diverted from prison and thus
  women who are incarcerated have had a longer
  exposure to hepatitis C outside prison 50 - 70
  of women inmates have been exposed to HCV
• 30 - 40 of men in Australian prisons have been
  exposed to HCV

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Prison prevention strategies

• No NSP though regularly called for
• Henna tattooing and prison sanctioned tattooing
• Improved barberingand blood safetystrategies
• Greater educationof prison staff

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Supervised injecting centre

• In Kings Cross (inner city with high street based
  injecting overdose rate)
• Established as harm reduction strategy to reduce
  overdose and highly regulated as a pilot project
• Considerable objection in media and some arms of
  government
• Point for interaction and diversion to prevention
  and therapy services

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Supervised Injecting Centre

• Has been run as aa pilot
• Has been evaluatedas effective inreducing harm
• Has reduced streetbased injecting
• Provided considerablereferral
• Constantly threatened

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Prevention of transition to injecting
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Interventions in drug use practice

• Treloar, C., Laybutt, B., Jauncey, M., van Beek,
  I., Lodge, M., Malpas, G., Carruthers, S. (in
  press). Broadening discussions of 'safe' in
  hepatitis C prevention A close-up of swabbing in
  an analysis of video recordings of injecting
  practice. International Journal of Drug Policy.

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Targeted education programs
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Chopped liver http//www.ilbijerri.org.au/show3.h
tm
Chopped Liver The Blak comedy show you cant
liver without Written by Kamarra
Bell-WykesDramaturgy by John RomerilDirected by
Rachael Maza LongFeaturing Isaac Drandich
Melodie Reynolds After huge success in 2006
2007, Chopped Liver is hitting the road again in
2008, with a massive five month tour around the
nation. In 2005, Ilbijerri teamed up with the
Victorian Department of Human Services, the
Victorian Aboriginal Community Controlled Health
Organisation, and the Hepatitis C Council of
Victoria to develop a play that would communicate
Hepatitis C prevention and education messages to
the Indigenous community. The result was Chopped
Liver, which has gone on to tour to over fifty
communities and prisons in Victoria and South
Australia over the last two years. This year,
with interest continuing to grow, Ilbijerri has
joined forces with key state and local health
bodies in NSW, Victoria, South Australia,
Tasmania and Western Australia to send Chopped
Liver out on its biggest tour yet. Told through
the stories of Lynne and Jim, the play uses
comedy to humanise the experience of Hepatitis C
and to break down social boundaries surrounding
the virus, raising awareness and opening
opportunities for discussion, prevention and
support. Its about knowing that people with
hepatitis C are so much more than Chopped Liver.
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South Australia Indigenous Project

• Dont be Buntha, Hep C Dont Let It Be

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Hepatitis A and B Vaccination

• Vaccination for atrisk groups
• Vaccination for allpeople who inject
• Increased HBVvaccination

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Leadership, political support policy

• Strong leadership is hugely important
• Leadership may not be public promotion
• Political support may not be political promotion
• Sound policy and research underpinning
  interventions will provide greater protection

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Acknowledgements

• Shehana Mohammed, Kirstie Ford, ASHM Secretariat
  Greg Dore, ASHM Board
• Carla Treloar, National Centre HIV Social
  Research
• Helen Tyrrell Hepatitis Australia
• Lisa Ryan, NSW Health
• Craig Rogers and staff from the SIGC and Kirketon
  Road Centre
• I do not have any conflicts or financial
  relationships with any individuals or companies
  and would like to thank the organisers for
  inviting me

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Monday 20 -
Wednesday 22
October 2008
www.hepatitis.org.au