Linkage to Care

Linkage to Care: What happens after Diagnosis of Hepatitis B or C

Hepatitis Free Pahang/Malaysia's campaign is motivated to raise awareness and to provide Hepatitis screening tests to the public. Hepatitis B has long been treatable and Hepatitis C is curable. Yet surprisingly large number of Malaysians are still dying unnecessarily from persistent infection with viralor hepatitis, notably from liver cirrhosis which kill an estimated 1500 people [1] and liver cancers which kill another 1750 people a year in Malaysia [2].

 

Linkage to Care: What happens after Diagnosis of Hepatitis B or C

There is no standard definition of Linkage to care. However HFM will try to link people diagnosed with viral hepatitis to health services (which may include hepatitis B or C viral load, Hepatitis C confirmation tests, assessment of liver disease and treatment, management of chronic care as in the cascade

 

How could HFM provide Counseling and Linkage to Care?

What are the strategy(ies) that addresses Linkage to Care by HFM?

HFM will try to link those tested positive to care

As announced on March 19 that chronic Hepatitis C patients will have access to hepatitis C (direct-acting antivirals, DAA) treatment is at 18 selected government hospitals through compulsory licencing

The list of the 18 selected government hospitals across the country are:

  1. Hospital Tuanku Fauziah
  2. Hospital Sultanah Bahiyah
  3. Hospital Pulau Pinang
  4. Hopsital Raja Perempuan Bainun
  5. Hospital Kuala Lumpur
  6. Hospital Tengku Ampuan Rahimah
  7. Hospital Selayang
  8. Hospital Ampang
  9. Hospital Serdang
  10. Hospital Sungai Buloh
  11. Hospital Tengku Ampuan Afzan
  12. Hospital Raja Perempuan Zainab II
  13. Hospital Sultanah Nur Zahirah
  14. Hospital Tuanku Jaafar
  15. Hospital Melaka
  16. Hospital Queen Elizabeth
  17. Hospital Umum Sarawak

 

HFM Linkage to Care Program

  • Identifying persons infected with viral hepatitis early in the course of their disease - Earlier diagnosis and improvements along the entire continuum of care can lead to reductions in the incidence of cirrhosis, liver cancer and liver transplantations.
  • Link and refer persons infected to care and treatment – HFM will find a medical provider for you to manage your hepatitis C infection.
  • Improve access to and quality of care for persons with viral hepatitis.
  • Develop networks to support specialty providers who are uniquely positioned and equipped to treat viral hepatitis
  • Advance research to enhance care and treatment of persons infected with viral hepatitis.

Treatment for Hepatitis C

Hepatitis C is now curable with simple, once daily medicines taken orally for a duration of only 12 weeks (longer for those with complicated liver disease), with a good safety profile (minimal side-effects) [4,5]. Treatment is initiated only for those who are screened positive and who "active" disease as determined by the presence of HCV RNA in the blood.

Directly Acting Anti-Virals (DAAs) are highly effective and can completely cure HCV infection with a short duration of treatment. They are breakthrough treatments for Hepatitis C with very high cure rates of 90% to 99% depending on genotype (type of virus), severity of disease, treatment experience, and other factors [5].

Unfortunately, as often in Malaysia, new and advanced medicines are often priced out of reach for all but the wealthiest or well-connected patients. HFM/HFP is therefore also committed to assisting people who are found to have Hepatitis C through our screening campaign to receive these breakthrough treatments:

  • HFP is therefore also committed to assisting people who are found to have Hepatitis through our screening campaign to receive the medical treatments which they will need:
  • HFP will help eligible patients to secure reimbursement from the relevant payers such as SOCSO (for eligible workers), JPA (for government servants), private health insurance and EPF Account 2.
  • HFP will finance the treatments for Hepatitis C for those who are truly poor, as determined by a means test. (only in Pahang state by Hepatitis Free Pahang).
  • HFP will finance the treatments for Hepatitis C for those who are truly poor, as determined by a means test. (only in Pahang state by Hepatitis Free Pahang).

 

Treatment for Hepatitis B

Malaysia has introduced a national Hepatitis B vaccination program for all new-borns since 1989. The prevalence and health impact of Hepatitis B will gradually diminish in our population over time [6]. However, many Malaysian adults (those born before 1989) will have been exposed without the protection of vaccine, and they will require screening for Hepatitis B and treatment if screened positive. Unlike Hepatitis C, Hepatitis B is not yet curable but it is treatable [7,8]. This means, there are effective treatments to prevent the Hepatitis B infected liver from progressing to liver cirrhosis and cancer (these are what kill a person, not the Hepatitis B per se). The current available treatments are not curative, which means a person with Hepatitis B will often need to be on life-long therapy [7,8]. Not all tested f Hepatitis B (HBsAg positive) requires treatment. Treatment is initiated only when Hepatitis B virus in the liver is "active" and there is evidence of liver disease [8.9]. A person with persistent Hepatitis B infection with therefore requires regular monitoring of his blood to detect the activity of the virus [8,9]. Hepatitis B is treated with medicines such as Peg-Interferon, Entecavir and Tenofovir. HFP is presently only committed to help finance the treatment for Hepatitis C but NOT for Hepatitis B yet (on account of limitation of funding).

HFP will help eligible patients to secure reimbursement for Hepatitis B treatment from the relevant payers such as SOCSO (for eligible workers), JPA (for government servants), private health insurance and EPF Account 2.

 

References

     
  1. Ali A Mokdad, Alan D Lopez, Saied Shahraz, Rafael Lozano, Ali H Mokdad, Jeff Stanaway, Christopher JL Murray, Mohsen Naghavi. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Medicine 2014, 12:145
  2. Globocan 2012. Available from http://globocan.iarc.fr/
  3. Relationship between Spending on and Access to Medicines, and Health Benefits foregone in a middle income country Malaysia. [Abstract by GF Ho, RP Kaur, AS Dass, Zaki Morad, TO Lim, submitted to 8th Annual Asian Oncology Summit 2016]
  4. World Health Organization (WHO). Hepatitis C Fact sheet 164, 2014. http://www.who.int/mediacentre/factsheets/fs164/en/ . Accessed 18 March 2017.
  5. World Health Organization (WHO). Guidelines for the Screening, Care and Treatment of Persons with Chronic Hepatitis C infection. Updated version April 2016. http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/ . Accessed 18 March 2017
  6. Ng KP, Ngeow YF, Rozainah K, Rosmawati M. Hepatitis B seroprevalence among University of Malaya Students in the Post-universal Infant Vaccination Era. Med J
  7. Malaysia 2013; 68: 144-147
  8. World Health Organization (WHO). Hepatitis B Fact sheet 204, July 2016. http://www.who.int/mediacentre/factsheets/fs204/en/ . Accessed 18 March 2017.
  9. World Health Organization (WHO). Guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection.
  10. http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ . Accessed 18 March 2017
  11. Sarin SK, Kumar M, Lau GK, Abbas Z, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2015. DOI 10.1007/s12072-015-9675-4