NOhep Medical Visionaries Forum – EASL 2023
Globally, millions of people living with viral hepatitis are unable to access care. The NOhep Medical Visionaries met at EASL in Vienna June 2023 to explore the barriers to accessing care and discuss solutions to make the elimination of viral hepatitis a reality. The session was facilitated and led by Dr Ahmed Elsharkawy, Honorary Senior Clinical Lecturer at the University of Birmingham, who was joined by Partizan Malkaj, Director of Albanian Hepatitis Organization and Rachel Halford, CEO of The Hepatitis C Trust. Here we look at the key themes discussed and any conclusions drawn as a result of the discussion.
The financial burden on patients with hepatitis C and their caregivers is high, making cost a barrier to care. The patient-borne costs associated with hepatitis C infection are often misunderstood, most cost-of-illness studies estimating only the direct medical costs of hepatitis C.
Even people with private health insurance are not always able to access treatment. In some countries, insurance claims are often rejected if a person is still using drugs or alcohol, or if their liver damage isn’t at an advanced stage, leaving many people no choice but to pay out of pocket.
Testing in A&E
London A&E departments have recently adopted opt out testing for HIV, hepatitis C and hepatitis B. This has resulted in a number of new diagnosis, in particular for hepatitis B where they have found three times as many people living with hepatitis B than HIV or hepatitis C.
Emergency department opt out testing could play an important role in finding the ‘missing millions’ who are unaware they are living with viral hepatitis. By normalising testing as part of an emergency department attendance when blood is drawn, we could help reduce stigma, reach communities which are currently being underserved by testing opportunities and lower the amount of people presenting with a late diagnosis. This is a highly cost-effective initiative which could improve people’s health and wellbeing outcomes, save health systems money through avoidance of expensive inpatient treatment, and avoid onward transmissions.
Linkage to care for hepatitis B
Increasing access to screening is a crucial step towards achieving the elimination of hepatitis B. However, the opt out testing in London A&E departments has highlighted that screening programmes must ensure that a pathway to care is included. Improved linkage to care could help resolve some of the most prevalent barriers currently faced by patients, such as the following and 4) a well-constructed demand for and provisioning of traditional medicine for hepatitis.
More training for medical professionals would help improve linkage to care. Developing effective communicational structures between medical professionals and patients should be a top priority in the fight for viral hepatitis elimination.
People living with hepatitis B are not well represented; advocates are missing in local communities and in public life, and personal testimony is minimal – this has resulted in a lack of confidence in communication, and people feel inhibited or anxious in coming forward to ask for information or support. In many countries, migrant populations have a higher prevalence of hepatitis B and this can make it more difficult for people to find peers. This is then further affected by stigma and discrimination. In people with a recent hepatitis B diagnosis, or among those who have never previously attended a hepatology or infection clinic, most have limited or no prior awareness of hepatitis B infection or its corresponding treatment. Knowledge among front-line healthcare workers is also often lacking, so information given to patients can be inadequate, incomplete or false.
Provision of accessible, relevant information and education for patients, families and healthcare workers, and an increase in advocates within medical professionals could be a positive solution to help overcome these barriers.