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HEPATITIS CIN PEOPLE WHO USE DRUGS

Improving Care for Hepatitis C:A Framework Approach

LONDON 2015

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Living through Hepatitis C:An individual journey

Jim Fearnley

• Narrative of events – what happened

• Subjective perceptions – what was it like?

• Suggestions to enhance the patient pathway

Items covered

What happened?1996: Diagnosis[1984/5: likely origin]2002/3: Interferon/ribavirin [response then relapse]2013:

- 3 x Encephalopathic episodes

- Coma/near-death- Multi-factorial cirrhosis- Life expectancy: 52% over

next 2 years

May-October 2014:- Sofosbuvir/ledipasvir &

ribavirin- Sustained virological

responseDec 2014: Liver transplant2015-present: Continued SVR

How did it feel?Diagnosis & after:l Ignorance: what and

how?l Shock: initial abstinence 'Asymptomatic complacency'First treatment:l Suspension of

judgementl Cautious optimism

After relapse:l Depressionl Self-destructive nihilisml DenialBeing symptomatic:l Terror and despairTreatment & transplant:l Suspension of hopel Optimisml Relief and gratitude

Supporting the patient journey

Educating GPs- particularly in non-

prevalent locations- the monitoring gapPublic information- transmission risks in

the home- - reassurance about

sexual transmission

Post-diagnosis support:- - Counselling for shock- - Explaining symptom

trajectories (including dormancy): living with ambiguity

l

Post-treatmentUnsuccessful treatment:

l Fatalisml Self-blamel Diverting nihilism and

self-destructive behaviour

l l Successful treatment:

l 'The contradictory addict'

- Likes risk- Is a creature of habit

l Resumption of risky behaviour l Current ex-PWID re-

infection levels comparable with non-PWIDs

l But what about the 'HIV effect' of enhanced medication?

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