Swiss Hepatitis Symposium 2023

The theme of the Swiss Hepatitis Symposium 2023 was the simplification of care for people with viral hepatitis. Simplification has many faces, as various speakers emphasised. However, it is crucial if the elimination of viral hepatitis is to succeed.

On a grey November afternoon, on the day of Bern's Ziibelemärit, a good 50 people gathered at Welle7. Another 30 or so people were connected via Zoom.

Markus Messerli, President of the Swiss Pharmaceutical Care Network and owner of a pharmacy in Baar, kicked things off. He presented a pilot study with pharmacies in Switzerland that have tested clients for hepatitis C. Thirty-six pharmacies were invited to participate. 36 pharmacies were invited and 21 began the screening programme. In total, over 400 patients were asked whether they were willing to be tested, 145 were tested. 18 patients had a positive antibody test. The evaluation showed that pharmacies are a good place to offer tests, especially to high-risk groups. However, this requires "kickbacks", i.e. the costs must be covered.

John Dillon, Professor at Dundee University, was connected online from Scotland and presented the successful microelimination of hepatitis C in the Tayside region of Scotland. Pharmacies played a crucial role in this. Their studies showed that the care of patients in the drug sector with chronic hepatitis C was significantly better in pharmacies than via the standard treatment routes. However, incentives are needed to encourage pharmacies to join in. Then they could cover all the steps from blood tests to diagnostics and treatment.

Niklas Luhmann heads the Department of Viral Hepatitis at the World Health Organisation (WHO). He shows that only a small proportion of infected people worldwide are diagnosed with hepatitis B or C, with the figures varying greatly from region to region. International guidelines are moving in the direction of simplifying diagnosis and treatment. The recommendations today emphasise decentralisation, integration and task sharing. In particular, this means that the care of those affected is moving away from specialised clinics towards primary care, which looks after people at risk. "Simplification" has different faces. This means, for example, a simplified algorithm in the clinic and care that includes general practitioners. Care must put the person at the centre. This is the only way to achieve elimination.

Margaret Hellard, infectious disease specialist from Melbourne, spoke about the simplification of hepatitis B care. The treatment guidelines are very complicated today. Other hurdles include the cost of testing in low- and middle-income countries. The infectiologist put forward the theory that all patients with chronic hepatitis B should be treated. There is no definitive evidence, but there are indications that this is the right approach. An infection with hepatitis B significantly increases the risk of developing liver cancer, even if the liver is not yet damaged. The risk is comparable to that of smoking a packet of cigarettes a day. We should see chronic viral hepatitis as a carcinogenic infectious disease.

An interview with a patient living with hepatitis B confirmed this view of the infectious disease specialist. The patient was born in Vietnam and came to Switzerland with his family in the 1970s. His sister tested positive for hepatitis B by chance - while donating blood. The whole family was then tested and it turned out that the patient had been infected with hepatitis B by his mother at birth. He let himself examine further years later and by then he had already developed liver cancer - without ever having had any symptoms. The doctor gave him only a short time to live. A shock for the father, whose wife was pregnant with their second child. This was followed by operations, months of hospitalisation and finally a liver transplant. With a lot of luck, the patient survived the cancer. Today, he and his family are doing well.

Andrea Bregenzer and Claude Scheidegger presented examples of how care can be provided in OAT programmes and in prison in Switzerland. Andrea Bregenzer showed that point-of-care tests are possible in pharmacies. Many problems have already been solved and diagnostics and access to treatment have already been simplified. However, many barriers remain, such as the lack of reimbursement for rapid tests. Claude Scheidegger, head of the SHiPP Swiss HepFree in Prisons Programme, presented initial results from Swiss prisons. The programme has included prisons from all parts of the country. While individual infections with hepatitis B and HIV were found, the prevalence of chronic hepatitis C is between 1 and 3 per cent. These are preliminary figures in a programme that is only just gaining momentum. The significance is therefore limited. However, it shows that those who seek will find. And: the statement often feared by prisons that the healthcare system is overburdened and care is too expensive is hardly true.

At the end of the lecture series, Patrizia Künzler-Heule, a nursing scientist from the Cantonal Hospital of Sankt Gallen, showed how interprofessional collaboration can simplify care. In so-called "nurse-led" care, which they have introduced in Sankt Gallen, a nurse accompanies patients through all stages of treatment. The nurse works closely with the hepatologists, but also with primary care providers or Spitex services. In this type of collaboration, the roles and processes must be clearly defined and everyone must be willing to learn from each other. This would ensure that patients' needs are optimally met.

The event concluded with a panel discussion in which participants explored the importance of pharmacies in healthcare and overcoming barriers to care.

SAVE THE DATE: The next Swiss Hepatitis Symposium will take place on 2 December 2024!


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