The theme of this year’s World Hepatitis Day, recognised on 28 July, is Let’s Talk Hep. It is a call to engage the public, policy makers, health professionals and affected communities to become better informed about hepatitis, and to promote dialogue about the transmission, screening and diagnosis, monitoring, and treatment of viral hepatitis. Overall, World Hepatitis Day aims to build momentum and accelerate progress towards achieving the World Health Organisation’s goal of elimination by 2030.
Talking hepatitis during COVID-19
COVID-19 has significantly impacted on people’s lives and raised challenges for continuing to support the complex needs of people affected by hepatitis, especially as these relate to treatment for viral hepatitis. The Victorian Department of Health and Human Services (DHHS) has nominated viral hepatitis testing, treatment and care essential services during the Victorian shutdown of non-essential services and activities. Their recommendations are to:
- Prioritise HIV, hepatitis B and C treatment access and where required move to phone consultation, telehealth and postal delivery for medications;
- Adapt outreach, community-based counselling and support to online and telephone platforms to ensure those at highest risk due to social isolation, age, an underlying health condition or a mental health condition continue to benefit from social and emotional support and a connection to community services; and
- Pause all non-essential face to face activities, including workforce training.
Given these recommendations, and the challenges they pose for communicating about health risks and treatment, it is timely to focus on best practice guidelines for initiating hepatitis testing.
Let’s keep talking hepatitis: Talking Testing Tools
In 2017, Jen Johnson Program Coordinator from the BBV Sector Development Program, ARCSHS, initiated a sector-wide consultation with health and community practitioners engaged in blood-borne virus testing (read the full report detailing the findings and recommendations from the consultation). The intention was to identify what constitutes best practice in hepatitis B and hepatitis C pre- and post-test discussions, with an emphasis on non-medical needs. Participants discussed the fundamentals of pre-and post-test discussion at length and provided many nuanced insights into the components of quality testing services. The Consultation found that stigma was the primary force constraining blood-borne virus testing in primary healthcare settings. Participants described a range of practices they used to avoid reproducing stigma and to support testing, treatment and care.
Together, these practices make up the approach we term stigma-sensitive practice. This is a set of practices that acknowledges the historical contexts of HIV and hepatitis C, uses language that is non-judgemental, does not require discussions about personal and intimate sex and injecting drug practices and importantly ensures that consent is gained.
Many participants acknowledged that while a clear definition of best practice in viral hepatitis testing is a valuable notion, it is not attainable in all healthcare settings. Best practice, therefore, needs to be flexible enough to be able to fit into a diverse range of settings that deliver hepatitis testing. In response to these findings, the Talking Testing Tools were developed to support general practitioners and other health professionals to discuss viral hepatitis in a stigma-sensitive way and adapt to different contexts and time constraints. They provide examples of how to: talk about confidentiality and notification; enquire about testing history; and provide basic information about viral hepatitis. They also provide a stigma-sensitive description of patient-led discussion about transmission, information on how to discuss support and treatment if the result is positive, and create a structure within which informed consent can be gained. Here is an extract from the hepatitis C Talking Testing Tool:
|TESTING CHECKLIST||PRACTICE TIPS||TALKING TESTING|
|□ Basic information|
about hepatitis C
□ Health literacy
|Use open-ended questions and support the patient’s health literacy.|
Reiterate or clarify the basic information about hepatitis C.
Ask the patient to repeat the main points to you.
What is your understanding of hepatitis C?
|□ Stigma sensitive|
about risk and
Direct questioning about practices associated with transmission is not required for testing and may cause discomfort for both the patient and the clinician.
Hepatitis C can be passed on when blood from someone with hepatitis C enters another person’s bloodstream. This is often the result of unsterile injecting of drugs, including steroids. It can also be passed on through unsterile medical, dental and tattoo procedures.There is a low risk of transmission during childbirth.
Read the full Talking Testing - hepatitis C toolkit here
World Hepatitis Day reminds us that despite the new political and social realities brought about by COVID-19, working towards the elimination of viral hepatitis remains important. Many people considering or currently accessing treatment may be experiencing new hardships due to COVID-19. Scaling up testing and treatment needs to occur in a manner that takes these new challenges into account, and that respects the fundamental dignity, diversity and human rights of those affected.