Treatment Plan For Hepatitis C

Hepatitis C Education And Counselling

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Hepatitis C educational programs provide access to the means to protect the individual and minimise the risk of hepatitis C transmission and are necessary and effective interventions for inmates and staff in custodial settings.

Access to Educational Materials

The ready availability of current, easy to understand information about hepatitis C in prison including its prevention and medical management supports inmates to prevent hepatitis C transmission and to seek testing and clinical assessment if they are at risk.

Purpose Developed Materials

Resources that are designed to meet the educational needs of groups of inmates are more effective communication tools.

Peer Education

The provision of peer education within the custodial setting is another effective and proven method to decrease the transmission of blood borne viruses.
Cooperative development of these programs between custodial staff and peer educators maximises their success.

Access to Counselling and Support Services

Improved access to support and counselling by a range of service providers will benefit individual inmates and the broader custodial community.

Eleventh Circuit: Floridas Treatment Plan For Hepatitis C

The Eleventh Circuit Court of Appeals held that the Florida Department of Corrections treatment satisfies constitutional requirements even though it does not require that Hepatitis C -positive prisoners be treated with expensive antiviral drugs during early stages of the disease.

The courts August 31, 2020, opinion was issued in an appeal brought by FDC. The appeal challenged a district courts order requiring FDC to treat all HCV-positive prisoners with direct acting antiviral drugs within two years of their diagnosis.

HCV attacks the liver, causing scarring or fibrosis that is scored from F0 to F4. The district court, after a five-day hearing in October 2017, granted a preliminary injunction that required FDC to treat prisoners with F2 , F3 , and F4 with DAAs.

The district court subsequently granted the prisoner class motion for summary judgment that included, but expanded upon, its preliminary injunction. The permanent injunction required FDC to treat prisoners with F0 and F1 with DAAs within two years.

FDCs plan for F0 and F1 level prisoners is to monitor their conditions and provide DAA treatment to those who have either have an exacerbating illness, such as HIV, exhibit signs of rapid fibrosis progression, or advance to F2. The Eleventh Circuit said FDC was not denying care, it just was not providing the particular course of treatment that they and their experts want or as quickly as they want it.

Healthy Tips For Living With Hepatitis C

The Mayo Clinic has identified some lifestyle changes you can make to help improve your health during your treatment for hepatitis C. They suggest that you:

Be careful with your medications. Some drugs, even those prescribed by your doctor, may have the side effect of causing liver damage. This is a bigger risk for people with hepatitis C. Talk to your doctor about whether you should avoid certain prescription or over-the-counter drugs.
Avoid alcohol. Drinking alcoholic beverages can make liver disease progress more quickly. Therefore, its best to avoid alcohol if you have hepatitis C.

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Is Hep C Curable

The latest drugs available for hepatitis C have high success rates when it comes to curing the condition.

In conversations with your doctor, you can discuss the full range of treatment options. Some of these are combination drugs.

But its important to note that not every medication may be effective for you, even if its for the right genotype.

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The Need For Guidelines

Some 200,000 Australians are infected with hepatitis C, which can be a debilitating and potentially life threatening disease. For the past 10 years it has been one of the most commonly reported notifiable infectious conditions. Those most at risk from the disease are the inmates of Australian prisons, where hepatitis C is six times more prevalent than in the general community. Recent studies indicate that one in three male inmates are hepatitis C antibody positive and that two thirds of all female inmates are, or have been infected with hepatitis C. These figures equate to up to half of the total fulltime prison population being infected. Each year between 5,000 and 10,000 inmates are released from prison into the community, highlighting that hepatitis C prevention and control requires an urgent concerted response from both corrections and public health sectors.

There is no vaccine to protect against hepatitis C virus infection, therefore prevention efforts are directed at behavioural change supported by services such as needle and syringe and drug treatment programs. Treatment for chronic hepatitis C infection is now available in Australia and offers people with hepatitis C a strong chance of cure in 50% to 85% of cases. Projections indicate that without a substantial increase in the number of people accessing treatment, the number of people with hepatitis C related liver cirrhosis will continue to increase to between 7,000 and 10,000 by 2025.

A Huge Demand For Screening

At the Rwamagana market, about 55 kilometres east of Kigali, people form a huge queue in front of a local building near the market stalls.

One-by one, each person approaches a desk, to register to be tested Hepatitis C. The doctor in charge of the hepatitis screening station calls through a megaphone explaining that screening and treatment are free. People continue to join the queue. In just a few hours, hundreds of people will be screened at this site. There is more: the Rwanda Ministry of Health is using the Hepatitis C screening opportunity to also screen for Hepatitis B.

A Hepatitis C screening campaign in Muhanga district drew thousands of Rwandans in March 2017.

One reason screening is successful is due to a new rapid diagnostic test that can be used on-site, costs just 1 USD, and offers results in less than twenty minutes.

It involves a quick finger prick so a nurse can squeeze a drop of blood into the kit sample well. The blood is mixed with drops of an assay diluent. Then, a short wait of up to just twenty minutes to find out ones hepatitis status.

If positive, blood is collected for a more specialized viral load test at a nearby laboratory to determine if the virus has cleared, or if there is a chronic infection. If the infection is chronic, the person will be referred to a doctor for follow-up including treatment.

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Hepatitis C Testing In Custodial Settings:

The National Hepatitis C Testing Policy

Voluntary testing for hepatitis C is available for all inmates in accordance with the National Hepatitis C Testing Policy which provides the framework for testing for hepatitis C in Australia, including within custodial services.

Risk assessment and Testing for Hepatitis C

Recommendations to inmates for hepatitis C testing are appropriate and based on thorough risk assessments.

Pre and Post-test discussion

Hepatitis A and B Vaccination

Co-infection with hepatitis C and hepatitis A and/or B can lead to worse health outcomes. Longer term imprisonment is an opportunity to protect inmates against vaccine preventable conditions such as hepatitis A and B.
Participation by custodial services in sentinel site surveillance programs for hepatitis C provides useful data to understand patterns of infection and to develop and evaluate prevention programs at an institutional and jurisdictional level.

F Grading The Evidence For Each Key Question

What is the new treatment for hep C like?

We will grade the strength of evidence for primary outcomes using the standard process of the Evidence-based Practice Centers as outlined in the AHRQ Methods Guide.43 The grade will be based on four major domains: risk of bias, consistency, directness, and precision of the evidence. We will classify the bodies of evidence pertaining to each primary outcome into four basic grades: high, moderate, low, and insufficient . As advised in the AHRQ Methods Guide, the number of studies that form that basis of given findings or conclusions will also be recorded. Additional domainssuch as dose-response association, plausible confounding, strength of association, and publication biaswill be assessed and reported as appropriate.

Table 2. Strength of evidence grades and definitions

Grade
Evidence either is unavailable or does not permit a conclusion.

G. Assessing Applicability

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Impact Of Hcv Treatment On Survival

In persons with chronic HCV infection, treatment with achievement of SVR12 or SVR24 has been shown to markedly reduce the risk of death, including liver-related and non-liver-related deaths. Recently, multiple studies have shown major survival benefit in persons with chronic HCV who achieve SVR with DAA therapy. The following summarizes key data related to the impact of DAA therapy on survival after achieving an SVR.

What Should I Tell My Healthcare Provider Before Taking Epclusa

Tell your healthcare provider about all of your medical conditions, including if you have ever had hepatitis B infection, liver problems other than hepatitis C infection, or a liver transplant if you have kidney problems or are on dialysis if you have HIV or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby or pass into your breast milk.

Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. EPCLUSA and certain other medicines may affect each other, or may cause side effects.

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Costs And Other Considerations

Much of the discussion about HCV treatment has focused on the costs of therapy given the large up-front prices. Based on average wholesale prices , the cost of 12 weeks of treatment can range from approximately $65,000 to $113,000. The AWPs for a single days therapy and a full 12-week course of treatment are provided in . If the patient requires a regimen that also necessitates the use of RBV, additional drug acquisition costs need to be considered however, as a variety of dosage formulations and manufacturers is available, this product is not included in the pricing table. It is important to consider additional monitoring costs or medical costs that may arise from the adverse effects of RBV therapy, such as hemolytic anemia, which may require use of an erythropoietin-stimulating agent or increased laboratory monitoring.

What Are The Goals For Treatment Of Chronic Hepatitis C Infection

Treatment of chronic HCV infection has two goals. The first is to achieve sustained eradication of HCV , which is defined as the persistent absence of HCV RNA in serum 12 weeks after completing antiviral treatment. The second goal is to prevent progression to cirrhosis, hepatocellular carcinoma , and decompensated liver disease requiring liver transplantation.

In a prospective study of 158 patients with chronic HCV infection and liver cirrhosis who received interferon-free therapies with direct-acting antiviral agents and 184 control HCV patients with untreated liver cirrhosis, the short-term risk for de novo HCC did not change.

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How Effective Is Treatment

Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.

Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.

There’s no vaccine for hepatitis C.

If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.

Your doctor or nurse will be able to advise you.

How Will My Provider Monitor Me During The Treatment

Your provider will meet with you during treatment to review how well you are tolerating treatment and review laboratory results. Laboratory tests help keep tabs on your health, track the viral load, and determine your response to treatment. You will be given specific dates to go get your blood tested at the lab during and after the treatment.

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Helpful Tips While Taking Hepatitis C Medications

Always follow your health care providers’ advice, particularly the instructions on taking your medicine.
If you have to cancel an appointment, call your provider and schedule a new one as soon as possible.
Take good care of yourself. Eat well, drink 8 to 10 glasses of water each day, and try to get a full night’s sleep.
Learn about the hepatitis C medications you are taking. This includes special risks and warnings.
If taking ribavirin, use sunscreen, wear long sleeves and a hat, and limit sun exposure.
Write down your doctor’s name and phone number. Carry this information with you at all times.
Write the names and amounts of the medicines you are taking. Carry this information with you at all times.

Pregnancy And Hepatitis C

“Primary Care-Based Hepatitis C Treatment” – Kellene Eagen, MD

The new hepatitis C medicines have not been tested in pregnancy.

You should not become pregnant while taking treatment as it could be harmful to unborn babies.

If you’re pregnant, you must delay treatment until after your baby is born.

Speak to your doctor before starting hepatitis C treatment if you’re planning to become pregnant in the near future.

You’ll need to wait several weeks after treatment has ended before trying to get pregnant.

Women taking ribavirin should use contraception during treatment and for another 4 months after the end of treatment.

Men taking ribavirin should use a condom during treatment and for another 7 months after the end of treatment. This is because semen can contain ribavirin.

If you become pregnant during treatment, speak to your doctor as soon as possible to discuss your treatment options.

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Hepatitis C Hero: Lean Proteins

Seek out healthy proteins like fish, skinless chicken and turkey, nonfat dairy, and lean cuts of meat. Maintaining a healthy weight is an important way to protect your liver and avoid fatty liver disease, and choosing lean proteins instead of fatty ones is a smart switch to reach these goals, says Andrew J. Muir, MD, professor of medicine at Duke University School of Medicine in Durham, North Carolina. On the other hand, eating fatty red meats can contribute to obesity and worsen the toll on your liver.

Hepatitis C Enemy: Raw Fish

If you have hepatitis C, skip the sushi or oyster bar to avoid potential food-borne illnesses. In fact, you’ll want to be careful about all raw seafood, says Graham, since developing a bacterial infection from raw seafood can worsen hepatitis C. She says it’s also wise to avoid unpasteurized milk and cheese for the same reason.

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Hepatitis C Enemy: Salt

Salt can promote fluid retention, which is a symptom of progressive hepatitis C, Graham says. It’s not just salt from the shaker that you want to avoid processed foods like frozen meals and baked goods are also loaded with sodium. If you have early-stage hepatitis C, a little sodium is okay, but when the disease is advanced, it’s a good idea to stay away from any added salt, she says. Talk with your doctor to find out how much salt you can safely consume.

Review Of Key Questions

Elimination viral hepatitis by 2030: What

For all EPC reviews, key questions were reviewed and refined as needed by the EPC with input from Key Informants and the Technical Expert Panel to assure that the questions are specific and explicit about what information is being reviewed. In addition, for Comparative Effectiveness reviews, the key questions were posted for public comment and finalized by the EPC after review of the comments.

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Hepatitis C Hero: Fruits And Veggies

When it comes to fruits and vegetables for a hepatitis C diet, it’s the more the merrier. They’re rich in fiber, which helps you feel full for longer, as well as other nutrients that support heart health. Low in calories and fat, they make it easier to reach a healthy weight, says Camilla Graham, MD, assistant professor of medicine at Harvard Medical School in Boston. That, in turn, can reduce your chances of both fatty liver disease and diabetes. This is particularly important because those conditions can accelerate the damage of hepatitis C, she adds.

A Bold Elimination Plan

WHO has called for HCV elimination globally by 2030. It defines this as screening 90% of the eligible population and treating 80% of those with chronic infection.

Rwanda is more determined, and plans to achieve Hepatitis C elimination by 2024.

The country formally announced the Hepatitis C elimination goal in December 2018, with a five-year plan.

We are increasing access to services, finding cases, raising awareness among the population and establishing new partnerships, says Professor Jeanine Condo, the former Director General of the Rwanda Biomedical Centre.

Professor Jeanine Condo, former Director General of the Rwanda Biomedical Center. speaking at the launch of Rwanda’s Hepatitis C elimination plan.

According to the plan, Rwanda will screen four million people aged 15 and above over five years. Of those, about 120,000 will need Hepatitis C treatment. Fully implemented, this plan should result in a drop of HCV prevalence from 4% to 1% by 2024.

“This is very exciting,” says Professor Condo. Given the social and economic costs of treating liver cirrhosis and cancer later, we believe Hepatitis C elimination is a strategic and humane investment today.

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