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More than 300 million people worldwide are unknown carriers of Hepatitis B and C infections which, if left untreated, can cause serious liver damage and even liver cancer. Most of these people have no symptoms until they are in advanced stages of the disease at which time there is little that doctors can do for them.
Which is why Dr Scott Davison, Heptalogist from Liverpool Hospital and his team have spent the last ten years working on projects aimed at identifying and screening people in South West Sydney (SWS) who are at-risk.
Dr Davison explains that SWS has a high percentage of at-risk groups due to the diversity of the population.
“Hepatitis has different rates of infection in different parts of the world and because we have well over 100 nations represented in substantial numbers in SWS, the rate of infection in migrants can be quite high relative to the overall Australian population,” he said.
The good news for these thousands of Australians is that there are effective treatments that are readily available. In the case of Hepatitis B, anti-viral therapy, given as a once-a-day tablet, can suppress the virus leading to low rates of liver disease if taken as advised. Patients with Hepatitis C have an even more favourable health outlook, with short (8 to 12 week) well-tolerated treatments leading to almost every patient being cured of the infection.
“The challenge we face in Liverpool, and around Australia, is that the majority of people with these viruses don’t know they have the infection so they don’t know they need treatment,” says Dr Davison.
Due to this problem, the team at Liverpool ran an eight-month (soon to be published) study where over 5,000 people were screened for Hepatitis B and C at Liverpool Hospital’s emergency department. The aim of the research study was, not only to identify infections in the cohort, but to also provide enhanced linkage to care and treatment.
“We were trying to unearth Hepatitis B and C infections amongst patients presenting routinely for care at our hospital and to test for the infection at a time when they might be concerned about other health issues.
“The national guidelines for management of these infections promote testing on the basis of several risk factors. We used this approach to narrow the focus of testing for ED patients,” Dr Davison explains.
The study included patients with the identifiable risk factors of birth outside of Australia, previous intravenous injecting and people from Aboriginal and Torres Strait Islander descent. The study showed that the group of patients at-risk for these infections demonstrated increased rates of blood markers for both Hepatitis and C.
“A lot of patients were presenting with advanced liver disease which had previously not been picked up. We have been able to educate them about the condition and link them to care. So, a lot of patients who might otherwise be untreated are now being treated for the condition,” Dr Davison explains.
In addition to this study, Dr Davison and his team are working on a number of projects to help identify at-risk patients in SWS. One of these includes testing mental health patients through the mental health unit in Liverpool Hospital.
“These people often have complex health issues which can distract distract medical practitioners from doing a risk-factor assessment. In fact, this community is under-treated in general because we’re so focused on treating their mental illness.”
Educating General Practitioners in the local area to identify at-risk groups and to diagnose Viral Hepatitis, specifically Hepatitis C, has also been another long-term project.
The World Health Organisation (WHO) has set a target for the elimination of Hepatitis by 2030 and this year’s World Hepatitis Day message “Find the missing millions” aims to find these unknown carriers. Projects like those of Dr Davison and his team in South West Sydney is a positive step towards achieving that target.
By Linda Music
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