Tackling hepatitis at home and in the community

July 27, 2023—World Hepatitis Day, marked every year on July 28, is a time for reflection and renewed motivation for Sofia Bartlett, a senior scientist for sexually transmitted infections and blood-borne infections (stibbi) at the BC Centre for Disease Control.

“Needless to say, I’ve been familiar with the virus for a long time,” says Bartlett, “But it was very coincidental that I ended up doing my PhD in hepatitis epidemiology.”

Bartlett’s dad told her he made a lot of mistakes in his earlier years and learned a lot of lessons the hard way. He used substances to cope with trauma he experienced as a child, and spent a number of years in prison for crimes he says were largely due to his substance use.

Hepatitis C is a blood-borne virus, and it can be transmitted through the sharing of equipment such as needles and syringes, used to inject drugs. Many people like Bartlett’s father, who have been previously incarcerated or use unregulated substances, acquire hepatitis C infections.

“The last time dad was incarcerated, he joined programs to support his journey to recovery," Bartlett says.

One of those was a theatre program, and the teacher leading it offered him a place to live once he got out of prison.

“That person was my Mum’s cousin, and the place she ended up helping dad find was the laneway house in Mum’s backyard," says Bartlett. “Dad was apparently quite charming as he ended up moving to the main house eventually. The rest is history."

Originally from Australia, Bartlett was hired to work with a viral hepatitis research group after she finished her BSc at James Cook University. She went on to pursue a doctorate in hepatitis clinical research and epidemiology in 2013, completing her PhD at the University of New South Wales in Sydney.

“At that time hepatitis C treatment was really beginning to change,” she says, “a revolution was occurring.”

We were on the forefront of really cutting edge research, and the things I was learning about would eventually save my dad’s life."

Life-changing treatment

Chronic hepatitis C infection can lead to serious health complications, such as cirrhosis, liver cancer, and death. The good news is that it is treatable.

Since 2018, new medications to treat hepatitis C have been available in B.C. Direct Acting Antivirals, or DAAs, come in the form of tablets taken daily for 8 to 12 weeks and are covered by the province's PharmaCare plan.

“There are no nasty side effects,” says Bartlett. “More than 95 per cent of people who complete the treatment will be cured, and there are also additional treatments available for people who don’t clear the first time.”

Her father was cleared of hepatitis C in 2015 but he had cirrhosis in his liver. When the liver is scarred and damaged it can't perform essential functions as well as it should. People who have cirrhosis need to get a liver scan every six months.

“In May 2020, Dad called to wish me happy birthday, and it occurred to me to ask when he last had a check up,” says Bartlett.

Her father said he was feeling great and his cirrhosis had improved. However, he hadn’t been tested in over two years and now lived in a different part of Australia.

“That August we got the news that there was a nodule on his liver about the size of a golf ball.”

Doctors monitored Jack closely and recommended surgery after noticing some changes to his liver in December 2021. When Bartlett visited her Dad in Australia a few months later, he was already out fishing, bushwalking and doing all his normal activities.

“Pathology testing on the tumour removed from Dad's liver confirmed that it was a primary hepatocellular carcinoma,” she says, explaining that the cancer was almost certainly caused by her father’s hep C infection.

“If it hadn't have been picked up as early as it was, this would have most likely been a fatal cancer.”

Bartlett’s dad was screened every three months after his surgery, but after 12 months of clear results he now goes for tests every six months.

“I’m so grateful I was able to help him and that we had the positive outcome that we did," says Bartlett.

“Dad is in the very lucky minority in terms of people who survive liver cancer. Liver cancer is consistently in the top five most common causes of death globally!”

Test Link Call

One promising initiative Sofia has started to help people living with hepatitis C is the Test, Link, Call (TLC) Project. It provides smart phones with six months of calling and texting credit to those who have experienced incarceration and are at risk of being criminalized, including people who use drugs and have unstable housing.

Participants receive a care plan along with their cell phone and can connect with peer mentors and social supports, which can help them navigate the health care system, access employment resources and find better living situations.

Bartlett says the Test Link Call project has empowered people living with hepatitis C to be more engaged with health care.

Bartlett says the BCCDC Foundation for Public Health recently confirmed that TLC will be funded for another year and the project is being expanded to support people with hepatitis C, hepatitis B and HIV to access care and treatment.

The Foundation is actively seeking donors to be able to continue supporting the program beyond next year.

“The approach I have to my work, especially projects like Test Link Call, is definitely informed through my family's experience with hep C, substance use and incarceration,” says Bartlett.

World Hepatitis Day events

Throughout the summer, there are a number of events marking World Hepatitis Day on July 28 and promoting better awareness, information about testing and treatment as well as the de-stigmatization of people living with these types of infections.

July 28

Vancouver: community hepatitis C testing and information at the Vancouver Urban Health Centre
Victoria: Dinner & Drag fundraiser with Mina Mercury at AVI Health and Community Services
Prince George: community hepatitis C testing and cultural event at the Fire Pit Drop-In Centre, hosted by Positive Living North: No khēyoh t'sih'en t'sehena Society
Fraser Valley: community hepatitis C testing & info event at In-Phase Clinic in Mission

Aug. 1 to Sept. 18

Interior: Health Initiative for Men (HIM) hosting pop-up private and confidential on-the-spot testing for STIs and blood-borne infections, including hep B and hep C in Shuswap, Kelowna and Kamloops.

Aug. 17

Maple Ridge: Community hepatitis C info & linkage to care event with Unlocking the Gates
Maple Ridge Community Hub, 22155 Lougheed Highway, 11 a.m. to 3 p.m.

Virtual:

July 20 & Aug. 20: Online peer support meetings for people living with HIV or hep C who were recently released from prison, through Phoenix Society PAICE program, from 6:30 to 7:30 p.m.

July 28: Pan American Health Organisation World Hepatitis Day 2023 webinar on 'Scale up Access to Diagnosis and Treatment to Save Lives', 8 to 9 a.m.

BC place in downtown Vancouver? lit up in red and yellow for World Hepatitis Day (Image provided courtesy of BC Place)

Contact
Heather Amos (she/her)
Manager, Communications and Engagement, BC Centre for Disease Control
Provincial Health Services Authority