“I am a Hep Hero because I strive to increase our knowledge of and improve our responses to hepatitis C, a disease that infects approximately 1% of all Australians.”
Over the next few years there will be a paradigm shift in hepatitis C treatment with the advent of new direct acting antiviral medications (DAAs). These new treatments, if used in combination with harm reduction approaches, will enable us to significantly reduce the impact of hepatitis C infection on the community. Elimination of hepatitis C is possible, but it will only happen if we actively work towards this goal. It is time for people to get on board!
I started working as an infectious disease physician in the mid-1980s. HIV rates were climbing rapidly and there was no cure. I soon began to look after people with hepatitis C and hepatitis B; again, the treatments were not very good. Moreover, I didn’t like how health services treated some people with hepatitis and HIV differently, not because of their illness but because of how they contracted their illness.
At that time I decided that prevention was better than cure and that no person should be stigmatised or receive reduced quality health care because they had or were at risk of contracting a blood borne virus infection.
I realised that many people in the community, including politicians and community leaders, were uncomfortable with prevention or harm reduction approaches (such as giving people who inject drugs clean needles and syringes) to prevent hepatitis C transmission and that it was important to provide evidence that such approaches were effective. For this reason much of my research has focused on understanding how hepatitis C is transmitted and examining the effectiveness of interventions that reduce transmission.
Even now, despite the evidence of the benefits of harm reduction strategies like safe injecting facilities, they are not always supported or funded by government. However, I think if we continue to work together (the affected community, researchers, health care workers and government) and provide clear and objective evidence, the community will have better public health policy and programs.
The same applies to hepatitis C treatment; until recently it was difficult for people who inject drugs to get hepatitis C treatment due to concerns by health professionals and others about the effectiveness of treatment in this group. Over the past 10 years my research at the Burnet Institute, and that of others in Australia and elsewhere in the world, has shown hepatitis C treatment is effective in people who inject drugs.
Mathematical modelling of the hepatitis C epidemic is a very recent and particularly exciting part of our research. It suggests hepatitis C can be eradicated over the next 20 to 30 years if we take a sustained multipronged approach that combines harm reduction interventions and the treatment of people who inject drugs. Although expensive, because the new medications are likely to cost a lot of money, it will be highly cost-effective as it will substantially reduce the health burden of hepatitis C.
I have been working with a team of researchers at the Burnet Institute and the Alfred Hospital in Melbourne for many years undertaking research to improve our understanding of the hepatitis C virus, prevent its transmission and improve its treatment. Much of this work has been based in community settings working with people who inject drugs.
Margaret’s message to others:
“Eliminating HCV in people who inject drugs is ambitious but possible with new highly effective and tolerable drugs, effective and relatively inexpensive harm reduction and prevention approaches, and the political will to implement them. The time to start is now.”
We acknowledge the traditional owners of the lands where we work - the lands of the Woi-Wurrung Wurundjeri people of the Kulin Nations. We express our gratitude to them for their continued care and curation of these lands and waters. We pay our respects to Elders past and present.
LiverWELL observes and honours the Kulin Nation's intrinsic connection to land, sky and water, and the creator Bunjil. LiverWELL is committed to being led and informed by Aboriginal and Torres Strait Islanders on bridging health outcomes for communities and improving liver health.