More to Be done to treat hep C patients, Doctor says
Until recently, Dr. Curtis Cooper has been forced to tell some patients with hepatitis C to, in effect, come back when they are sicker.
Costly drug therapies were available to cure the potentially deadly virus in just a matter of weeks, but under provincial rules, they were only funded for patients with more severe cases of the liver disease. Which meant many patients had to wait, and some just never came back.
“You would say, ‘We have great therapies that would cure you, but I can’t give it to you. Let’s wait for your liver disease to get worse and I will be able to treat you,’” said Cooper, director of the Ottawa Hospital and Regional Hepatitis Program.
Cooper is no longer having those conversations. Under provincial changes, drug therapies to treat hepatitis C are widely available for patients at all stages of the disease.
“It doesn’t matter who you are, where you come from or what your characteristics are, there is reimbursement,” Cooper said. “That is a huge move forward that hopefully will be duplicated elsewhere in the country.”
Improved treatments and better access to those drugs are part of a revolution that is saving the lives of people with hepatitis C, which if untreated can lead to liver failure and liver cancer. At the Ottawa Hospital and Regional Hepatitis Program alone, 400 people were cured of the disease last year, Cooper said.
Improved access to drug therapies could well increase that number this year. The program’s staff includes nurses and social workers who go into the community, including to shelters, to engage with patients. In some cases, staff deliver medication daily to patients who are struggling with mental health and other issues.
But Cooper believes more can and should be done to reduce the toll hepatitis C takes on individuals and society by finding and treating people who don’t know they ’re infected. More than 110,000 in Ontario have chronic hepatitis C infection and it is estimated 44 per cent of people living with chronic hepatitis C have no idea they are infected.
The Ottawa Hospital’s viral hepatitis program is working with the Ottawa Carleton Detention Centre to improve screening and treatment of inmates, who are among those with the highest risk of having hepatitis C.
About 20 per cent of people in jail in Ontario are infected with hepatitis C, compared with a rate of about 0.7 per cent among the general population. Many of those cases go undiagnosed and untreated, which raises the risk of further spread.
Cooper said his clinic has always had some patients from the detention centre who have been identified, but is working on a more formal program to screen, treat and connect with more inmates. A key to the program is staying connected to inmates after they have been released to allow treatment to continue.
He calls the program — a partnership between the hospital’s viral hepatitis program and the detention centre (with funding from Gilead Canada, which produces a number of hepatitis C treatments) — a “unique opportunity to connect high-risk populations with immediate health-care services.”
Cooper believes more must be done to reduce and eventually eliminate the disease. He is among physicians pushing for universal screening in Canada, something done in Australia and other countries, to identify undiagnosed cases of hepatitis C. Rather than looking at high-risk populations, Cooper says, testing everyone would reduce the stigma and could eliminate hepatitis C. But there has been no move to do so in Canada.
“This is a major source of frustration for all of us in Canada who are trying to do the right thing on hepatitis C.”