Issue 45 September 2009

Contents
All Pages
Page 13 of 14

Providing Treatment

A critical look at increasing treatment update

Carla Treloar of the National Centre in HIV Social Research recently co-authored a paper about the various initiatives planned to increase hepatitis C treatment uptake in Australia. Published in the Drug and Alcohol Review in July, ‘Hepatitis C treatment in pharmacotherapy services: Increasing treatment uptake needs a critical view’ examines the implications of this new approach to treatment delivery.

The rising incidence of HCV infection, and increasing government awareness of the problem, has led to efforts to expand the delivery of HCV treatment into non-specialist areas of medicine, such as general practice clinics and pharmacotherapy clinics (see pages 14 and 16 for the most recent South Australian developments).

Treloar and her co-author, Suzanne Fraser of the Centre for Women’s Studies and Gender Research at Monash University, argue that there is a real need “for more qualitative social research if we are to understand adequately [the influences] on the potential for success of hepatitis C treatment services in new sectors.” Projections from the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmitted Infections, which reports to the federal government, suggest that the current rate at which people are taking up hepatitis C treatment needs to triple if the burden of the disease is to be kept under control. It is in order to achieve this that the increasing decentralisation of treatment supply has been happening.

One of the common alternatives is to offer hepatitis C treatment at IDU treatment centres, sometimes described as opioid pharmacotherapy treatment (OPT) centres. The researchers argue that unfortunately there is often a very low understanding of the nature and risks of hepatitis C among people attending OPT centres.

Another problem appears to be that many people associate the interferon-induced ‘flu-like’ symptoms, a common side-effect of hepatitis C treatment, as being similar in nature and severity to opioid withdrawal symptoms, and so increase a person’s likelihood of returning to injecting drug use if they have given it up.

Discrimination is another major problem with treatment uptake. Treloar and Fraser state that moving the treatment availability to a different setting does not make this problem go away. Some research even suggests that people with hepatitis C are treated less well than other clients at drug treatment clinics, even though injecting drug use itself is already highly stigmatised by broader society. As the report notes, “evidently, introducing hepatitis C treatment into services where staff have not all received adequate training in hepatitis C-related issues, or have not actively chosen to work with this group, can mean patients’ experiences of support and respect are at best uneven.”
Other issues such as housing problems, poverty or court proceedings and criminal records can also work against somebody successfully taking up treatment. All of these can lead to clinicians labelling a person’s life as ‘chaotic’, which disqualifies them from receiving hepatitis C treatment. Treloar and Fraser say that even attending an OPT service can be problematic, as they are often not very secure (for clients, as well as staff), exposing vulnerable people to the possibilities of violence or stress—factors which can, in turn, make the side-effects of treatment, such as depression, even worse.

Because of this, the researchers claim that OPT services may well need to be reconsidered and redesigned to make them effective and appropriate places for providing treatment for hepatitis C.
The full text of ‘Hepatitis C treatment in pharmacotherapy services: Increasing treatment uptake needs a critical view’ is available from the HCCSA Library.

Note: For a different view of treatment in OPT centres, see the next article.

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