10 Minutes with a Hep C Nurse for World Hepatitis Day
In honour of World Hepatitis Day, we spoke with Nicky Cooper, one of Te Whatu Ora - Nelson Marlborough’s public health nurses working with the Hepatitis C Community Service.
Nicky’s work connects her with our community’s most vulnerable. People who are most at risk of developing Hep C are those who have injected drugs intravenously and those who have received a tattoo or piercing with potentially unsterile equipment. Also at risk are people who have been to prison, had a blood transfusion before 1992, and those who have lived in or received medical attention in high-risk countries.
“Anyone with a history of intravenous drug use, past or present, would be seen as high risk. Even if they have injected drugs just once,” Nicky says.
Hepatitis C in New Zealand
There are an estimated 45,000 people in New Zealand with chronic Hep C viral infections and there are approximately 1,000 new cases every year. Due to the fact that symptoms can take decades to declare themselves, it is estimated that 40 to 50% of people with Hep C are undiagnosed. When symptoms do appear, they can be mild or non-specific, like tiredness.
To connect with individuals who are at high risk of being undiagnosed for Hep C, Nicky visits needle exchanges, corrections units, pharmacies with methadone programmes, homeless shelters, and police stations.
“I spend a lot of time with people that are displaced or in emergency housing. It’s a case of getting yourself out there, getting known, and then saying in a very non-judgemental way, ‘here is what I can offer you while I’m here, what do you know about Hepatitis C, is this something you have ever considered being testing for?’”
Testing for Hep C - Point of Care Testing:
Once she makes that connection, Nicky performs what is referred to as Point of Care Testing: a test that can be done outside of a traditional lab.
“They’re like little RAT tests, but with a finger prick for blood. We can get an instant answer as to whether someone has Hep C in their system or not.”
Testing and treatment for Hep C have never been as simple and effective as they are now, Nicky says. Though a blood test is required to confirm the result, the ease of a finger-prick test is breaking down barriers to diagnosis.
Testing to assess for Hep C-related liver damage has become simpler and less invasive, too. In addition to liver biopsies, which only radiologists perform, the Fibroscan is a new option at the primary care level which can be performed by a nurse or GP.
Antiviral Treatment for Hep C:
A recently developed antiviral treatment – Maviret – shows a cure rate of 98%. As Nicky says, “it’s pretty amazing. There are not many medications that can do that.”
Maviret is simple to administer with minimal side effects, a welcome change from previous Hep C medications which Nicky says had similar side effects to chemotherapy.
A Positive Outlook for Hep C
The work done by Nicky and her public health colleagues is a result of the National Hepatitis C Action Plan, launched on last year’s World Hepatitis Day. The Action Plan focuses on increasing support for nurses to diagnose the undiagnosed at the community level, as well as providing pathways for further prevention, education, and treatment.
With easier testing, more effective treatment, and services that directly engage at-risk populations, Nicky is seeing more and more positive outcomes— for Hep C patients, but also for everyone she interacts with during testing. Meeting people where they are at goes far in reaching populations who do not typically trust or engage.
Public Health Support for Hep C
“The role is about what public health really is, which is population health and serving our vulnerable populations. You’re a navigator in some respects—you might be the right person on the right day that someone wants to have a conversation with. Anyone who works in addictions knows it’s not a smooth path forward, but it might be that you’re the one person they feel safe with, and that can be make or break.”
Nicky is pursuing qualifications that would enable her to prescribe Hep C medications within the community as this will remove further barriers for patients who cannot afford GP visits.
In the coming months, she is looking forward to when the Southern Hepatitis C Mobile Van makes its way to the Nelson Marlborough region. The testing van sets off on its journey around the South Island this World Hepatitis Day.