Write about the Essay Report on Hepatitis C Virus.
Hepatitis C virus is a worldwide public health concern that has lead to global monitoring of its spread and the epidemiological picture of HCV infection. Globally it affects between 64- 103 million people who are chronically affected, (WHO, 2016). Most of these category risk morbidity and dying, (McCombs et al., 2014). Most at risk group have been the intravenous drug usage in both developing and developed countries. Social vulnerabilities such as unemployment, homelessness and limited access to social health care have been triggering drug usage which translates to increase risks of Hepatitis C Virus infection, ( Ruta, & Cernescu, 2015). Chronic hepatitis C virus, affects the liver cells with long term complications.
Hepatitis C virus transmitted through exposure to contaminated blood infecting the liver. Most infections occur through sharing of needles and other equipments. It is estimated that 70-80% of those infected develop chronic infection which end ups to have other long term effects, (CDC, 2017). People at risk of acquiring HCV, include drug users, chronic haemodialysis patients, people with exposure to Hepatitis C Virus such as health care workers, blood recipients, people living with HIV and children born to Hepatitis C Virus positive mothers. It is estimated by most recent surveys that a third of young 18-30 years are hepatitis c virus infected. Older infection drug users have more prevalence rate of 70%-90% of Hepatitis C Virus infection. In Australia, Hepatitis C Virus affects approximately 230,000 people who are at risk of developing liver fibrosis leading to cirrhosis. It is the common cause of liver diseases in Australia, (GSA, 2017). In most cases Hepatitis C Virus has been spread through health care setting, with sharing of injectable objects or with injectable drug users. It is often detected through performance of several tests which include screening tests for antibody to Hepatitis C Virus, qualitative tests to detect presence or absence of virus or polymerase chain reaction and quantitative test to determine amount of virus.
Diagnosis of Hepatitis C Virus, has been always been done through specific blood tests, screening tests, (Chhatwal, 2016). Acute hepatitis C cases typically go untreated as they do not have symptoms. Currently there is no treatment of Hepatitis C Virus; the key management tool is by avoiding behaviours that can spread the infection.
The historical perspective of Hepatitis C Virus resulted from identification of A and B 50 years ago. With the aid of technology, molecular biological studies have led to cloning of hepatitis C virus in the year 1989. In-depth knowledge of HCV has led to better knowledge on diseases such as hepatitis, cirrhosis, liver diseases. Hepatitis was discovered by Dr. Bluberg, in 1963 through the discovery of an antigen that showed presence of Hepatitis B Virus in blood samples. At the time Dr. Blumberg was researching genetics of disease susceptibility but his effort led to knowledge of hepatitis C virus. His team discovered a unique antigen from an Australian Aborigine, which they referred Australian agent. With further research it was found out to be causative agent to hepatitis B. They later developed a vaccine for this strain which was used worldwide for prevention services. Throughout the years advances have been made till in 1989, whereby Hepatitis C Virus, was isolated. Vaccine for HCV, has not yet been invented, however 80% of cases who complete treatment course can be cured. The virus is a member of the family Flaviviridae and is cause of approximately 20% of clinical viral hepatitis.
Knowledge of hepatitis C Virus on an individual, involves changes to individuals well being, new identity status, lifestyle changes through psychological concepts. Studies have shown that social and cultural angle affects the well being of HCV individuals. There are four dimensions of self that have been found; relationship of self to others, emotional self, self stories and identity and self scrutiny and relationships. These social cultural perspective have been found to translate to the explanation of the transition period following HCV positive diagnosis.
With the increase in modernisation, tattooing has been the next big thing among younger adults. The global prevalence of tattooing has been increasing over the years. In US 36 % of people under 30 years have tattoo. In Australia the case is the same, approximately 12 % of individuals have one or more tattoos in their body. Risks have been associated with usage of tattoos, concerns have risen concerning sharing of needles without sterilization and proper hygiene practices. Tattoo dyes are not kept in sterile bottles; hence they might play a role in transmission of infections. Tattooing play an important role in transmission of blood borne diseases such as hepatitis c virus. Tattoo exposure is associated with HCV infection, all patients with tattoos should be treated high risk, and thus programs should be geared towards covering individuals with one or more tattoos. Prevalence of tattooing is among the youth; hence awareness campaigns should be directed towards this clientele. Commercial parlours have been associated with HCV transmission, from reuse of non disposable needles, inappropriate sterilization of equipment or reuse of ink contaminated with blood. Tattooing in prison set ups has been a concern, especially in transmission of blood borne infections; it is typically performed using non-sterile material.
People who inject drugs have shown to be infected with HCV, but they are unaware of the infection. According to Ruta & Costine, (2015) one in ten people are treated for HCV, leaving the rest with chronic infection without antiretroviral drug management.
Multiple sexual partners have been associated with increase infection of HCV, several factors have been attributed to this which include, increased biological vulnerability due to HIV and STIs, increase in risk in behaviours such as unprotected sex, serosorting behaviours which involves engaging in unprotected sex with individuals of same sex status, traumatic sexual practices, multiple partners, group sex, recreational drug use. HCV and HIV positive men is driven mainly by combination of biological vulnerability and behavioural risk behaviours.
HIV and HCV have shown to portray similar characteristics having high co infection rates, (Platt, 2016). Highly active antiretroviral therapy has reduced HIV related mortality and morbidity.
Treatment s for treatments of hepatitis c, involves a variety of antiviral medications, (Sarrazin 2016). Center for Disease Control has recommended various groups for screening which include, people who inject drugs, people who are HIV positive, abnormal liver tests, patients who receive donated blood or organs before 1992, people who are exposed to blood on the job and people who are on haemodialysis.
According to WHO, the standard care for hepatitis C is evolving daily. Most recent treatment has been on therapy with interferon and ribavirin. Antiretroviral drugs have been modified to treat HCV. They are referred to direct antiviral agents, which are safer and tolerated than the previous therapies. These drugs are expensive and are not affordable to many middle income and low income countries.
HCV are prevalent in correctional settings worldwide, and yet antiviral treatment is inadequate. The prevalence of HCV infection in prisons is approximately 30%. Series of Meta analysis studies from different countries showed an association between the prevalence of HCV infection and history of injection drug use, (Bretana, 2015).
In Australia, there more than 30,000 prisoners at any one time, (Mina et al., 2016) than 30 % of these test positive. It is with this concern that prisoners are considered a risky group. Transmission of HCV in prison settings is high, with the rise of the prevalence which needs expansion of prevention programs to reduce the infection and transmission.
Preventions strategies have been developed by ( WHO, 2016) and recommended for use, since there are no vaccine prevention services are paramount. Both primary prevention and secondary prevention have been used. Primary prevention measures include hand hygiene, safe handling and disposal of sharps and waste, providing of comprehensive harm reduction services, blood testing of donated blood, training of health personnel and promotion of correct and consistent use of condoms. Secondary prevention include education and counselling on options of care and treatment, early and appropriate medical management including antiviral therapy to prevent co infection, early and appropriate medical management including antiviral therapy and regular monitoring for early diagnosis.
Screening services for Hepatitis C Virus has been advocated for at risk population and those who engage in behaviours that exposes them to risks, (Ramirez, 2016). If positive Hepatitis C Virus detected, another test be done to diagnose chronic infection. But with those already infected, further screening is recommended for alcohol use and counselling is done to reduce moderate and high levels of alcohol abuse. Further assessment of liver fibrosis determines the level of damage caused.
WHO has recommended screening for patients with chronic HVC for antiviral treatment. Current recommendations root for treatment with direct acting antiviral as they are more interacting and strong, (Asselah, 2016).
The focus of healthcare systems with respect to people, who inject drugs, is that there must be an early detection and treatment of infection, to avoid late manifestation which brings complications later such as liver cirrhosis, (Baranoski, 2016).
With varied courses of hepatitis C virus, treatment has always been with antiviral drugs that reduces the viral workload. Reduction of risks involve non injection drugs or by stopping or not sharing of needles, syringes, avoidance of sharing personal items, consider risks if you think tattooing, body piercing and if you are having sex with more than one partner or usage of latex condoms to prevent infection.
In responding to the changing epidemic of hepatitis C infection, there are some barriers and challenges that have been encountered. Acute HCV is asymptomatic and young injectors on those who inject drugs are reluctant to seek help. The young and nonurban injectors have always difficult to meet for prevention and cure activities, as they are difficult to trace down. And further treatment may be hard to get. In other countries like US, different approaches have been utilised, to assist those dependent with drugs. They have developed syringe exchange program, as a way to make contact with this group, however they often utilise the option of disinfecting syringes and other drug preparation equipment. Safer injections have been advocated and adopted as a safer way of HCV prevention. However differentiating HIV and HCV persons is often a challenge. Risk reduction and safe injections considers the following ; new injectors need prevention information because of lack of injection competency, effective strategies for HCV prevention messages, attention on drug preparation, HCV viral infectivity on injecting surfaces can persist for days given good conditions, drug preparation equipment of syringes and needles, (Edlin, 2016). Safe use of filters, as a key component for safe injections, educating this category of people plays a key role in giving them the knowledge and capability to protect themselves and their injecting partners from HCV transmission. Developing meaningful education, unique messaging should be used that is developed culturally and utilizing local networks and institutional framework to provide easy guidance.
Conclusion
In managing hepatitis C virus, there is need to need to understand the contextual issues affecting the environment in order to come up with effective strategies of managing the disease. Family networks play a crucial role in reaching out to these patients, as they form a support team. Youth friendly strategies need to be adopted for easier penetration. As a collaborative network, there is need to include the voices of young people, address social networks that are involved and leveraging opportunities that are available in health care institutions. (WHO, 2016), has come up with recommendations guideline on how to manage Hepatitis C virus. This guidance needs to be followed to the latter, including screening for the most at risk group of people. As per to drug users, expanded access to sterile preparation and injection equipment for drug users who are chronic users of drugs need to considered for appropriate measures.
References
Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement . Melbourne: Gastroenterological Society of Australia, 2017.
Ruta, S., & Cernescu, C., 2015. Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes. World Journal of Gastroenterology?: WJG, 21(38), 10811–10823. https://doi.org/10.3748/wjg.v21.i38.10811
McCombs J, Matsuda T, Tonnu-Mihara I, Saab S, Hines P, L’Italien G, Juday T, Yuan Y. The Risk of Long-term Morbidity and Mortality in Patients With Chronic Hepatitis C
Results From an Analysis of Data From a Department of Veterans Affairs Clinical Registry. JAMA Intern Med. 2014;174(2):204-212 doi:10.1001/jamainternmed.2013.12505
Baranoski, A.S., Cotton, D., Heeren, T., Nunes, D., Kubiak, R.W. and Horsburgh, C.R., 2016, January. Clinical liver disease progression among hepatitis C-infected drug users with CD4 cell count less than 200 cells/mm3 is more pronounced among women than men. In Open forum infectious diseases (Vol. 3, No. 1, p. ofv214). Oxford University Press.
Rapid response, 2017. Accessed on 03/04/2017. https://www.ohtn.on.ca/rapid-response-101-epidemiology-of-hepatitis-c-virus-infection among-men-who-have-sex-with-men-2/.
Bretaña, N. A., Boelen, L., Bull, R., Teutsch, S., White, P. A., Lloyd, A. R., … on behalf of the HITS-p investigators., 2015. Transmission of Hepatitis C Virus among Prisoners, Australia, 2005–2012. Emerging Infectious Diseases, 21(5), 765–774
Edlin, B.R., 2016. Access to treatment for hepatitis C virus infection: time to put patients first. The Lancet Infectious Diseases, 16(9), pp.e196-e201.
Ramirez, G., Cabral, R., Patterson, M., Schoenbachler, B.T., Bedell, D., Smith, B.D., Vellozzi, C. and Beckett, G.A., 2016. Early identification and linkage to care for people with chronic HBV and HCV infection: the HepTLC initiative. Public Health Reports, 131(2_suppl), pp.5-11.
Weinstein RA et al. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clinical Infectious Diseases 2012; 54: 1167-78
Asselah, T., Boyer, N., Saadoun, D., Martinot?Peignoux, M. and Marcellin, P., 2016. Direct?acting antivirals for the treatment of hepatitis C virus infection: optimizing current IFN?free treatment and future perspectives. Liver International, 36(S1), pp.47-57
Sarrazin, C., 2016. The importance of resistance to direct antiviral drugs in HCV infection in clinical practice. Journal of hepatology, 64(2), pp.486-504.
Platt, L., Easterbrook, P., Gower, E., McDonald, B., Sabin, K., McGowan, C., Yanny, I., Razavi, H. and Vickerman, P., 2016. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. The Lancet infectious diseases, 16(7), pp.797-808.
He, T., Li, K., Roberts, M.S., Spaulding, A.C., Ayer, T., Grefenstette, J.J. and Chhatwal, J., 2016. Prevention of Hepatitis C by Screening and Treatment in US Prisons Prevention of Hepatitis C in US Prisons. Annals of internal medicine, 164(2), pp.84-92.
https://www.ncsl.org/research/health/hepatitis-c-overview.aspx . Accessed on 03/04/2017.
Center for Disease Control. Accessed on March 2017. https://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFact Sheet.pdf.
World Health Organization, 2016. ‘ Hepatitis C infection’. Viewed on 3rd March, 2017, http; www.who.org.hepatitis c infection.
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