You visit your doctor. The bad news is: you have a virus in your body, which, if left unchecked, could cause serious damage to your liver, maybe kill you. The good news is: it has no symptoms, for now, and can be managed with regular check-ups - even cured with the right treatment. What do you do? You make those check-ups your number-one priority.
Now imagine you’re homeless. You have no money, no support, no bed - no address for those appointment reminders. Your priority is a bed for the night, or a dry sleeping bag, your next meal. You’re battling poverty, maybe alcohol or drug addiction, maybe ongoing psychiatric problems. That Hepatitis C diagnosis slides right down the list.
One in three homeless people in Ireland are Hepatitis C positive. That compares to one in 10,000 in the general population.
This week is National Hepatitis C Awareness Week in Ireland and to mark it, the Hepatitis C Partnership today launched its Know Your F-ing Story campaign. The F, in this instance, refers to your F-score, the result provided by a simple, quick and painless fibroscan. Throughout the week, a “Fibro-Van” mobile testing unit will be stationed at various clinics across Dublin, offering these scans free of charge to anyone with Hepatitis C.
The Hepatitis C virus was identified in 1989. A communicable disease, Hepatitis C is spread from person to person by contact with infected blood or body fluids. About 15,000 people in Ireland have been diagnosed with Hepatitis C, and up to 15,000 more are estimated to be living with the disease undiagnosed. Globally, between 130-150 million people have chronic Hepatitis C and some 700,000 people worldwide die each year from related liver diseases.
Yet, it is a great time for Hepatitis C treatment: we can detect the virus quickly, monitor its progress painlessly, and cure the disease in almost 100 per cent of cases with treatments that far less invasive and far more effective than their predecessors.
But the only people accessing effective treatments in Ireland are high-functioning patients. If you look at patients treated so far under the National Hepatitis C Strategy, it’s the best players: the ones who show up for hospital appointments get treatment. The ones who don’t - arguably the most vulnerable populations - are not accessing care.
If you talk to any of the GPs working in drug clinics and homeless centres across Dublin, they will tell you their patients have a lot of problems - Hepatitis C is just one of them. Getting them to keep appointments at the Mater or St James’s or any other hospital - it just doesn’t work. This has been shown time and again. But there has always been a bias in Hep C treatment in a hospital setting: show up for your appointments, stop drinking, stop doing drugs, and maybe we’ll give you the treatment - or maybe we won’t because you’ll just get reinfected.
One in three homeless people in Ireland are Hepatitis C positive. It is worth restating that figure. Rather than create further barriers to their treatment, we as a society have a moral imperative to go out and assist vulnerable populations in identifying their illness, in assessing the stage of their Hepatitis C, and in helping them to access treatment. The GPs and homeless services that are managing these cases understand this and they are showing what can be done at community level with minimal supports.
Last month, HepCare Europe was formally launched with a €1.8m grant from the EU. The project focuses on providing a model of integrated care for treatment of the Hepatitis C virus based on partnership between primary and speciality care providers to allow for more efficient use of limited specialist resources. The project does three key things. It identifies those not accessing care. It engages community-based organisations to provide peer support to those with the virus to help them access care. And it develops links with nurse liaisons so that the treatment comes to the patient, rather than the other way around.
Patients are tested in the community. They have the health of their liver evaluated in the community by means of a novel fibroscan test, which has replaced the more invasive liver biopsy. Community-based treatments are piloted, along with lifestyle advice and peer supports.
In Ireland, our goal is to bring the HSE, the Government and community services together to develop a model of care and pilot it in the community to show that we can actually reach these vulnerable populations and treat people with the disease before they show up in emergency departments.
A great opportunity exists to make Hepatitis C a rare disease in Europe. We have the resources, we have the networks, we have the know-how - we just need to work together together to put them to the most effective use.
For more information about National Hepatitis C Awareness Week see www.hepinfo.ie.
Dr Jack Lambert is a consultant physician in Infectious Diseases at the Mater and UCD School of medicine.