The Role of Diagnosis

and

Linkage to Care

Rui Tato MarinhoMD, PhD, Gastroenterologist and Hepatologist

Vice-President Portuguese Society Gastroenterology

VHPB and UEG Member

ruitatomarinho@sapo.pt

All oral for All

97% SVR

The Liver Circle

Complex Medical Condition

AcuteHepatitis

ChronicHepatitis

CompensatedCirrhosis

DecompensatedCirrhosis

Liver

Cancer

Transplant

PalliativeCare

Dying

Hepatitis C is (also) a liver disease

Once Upon a Time

2014-20151989 19971991

2005FibroScan2001

80% PWID

~1-1,5%

HCV 3% world

96%

PLAN?

Lisbon

2010

Liver Unit and Outpatient

Some Data

Fibrosis/Cirrhosis

Benchmarking

HCV and PWIDs▪ All oral for All (Ministry of Health, ACSS, Infarmed)

▪ Doctors, others, HCP, with know-how (liver, HCV, PWID, HIV)

▪ Good liver transplant organization

▪ Legal System (Decriminalization)

▪ Patient Associations in the field (GAT, SOS, Fórum)

▪ PWID with support, facilities

▪ NGO (Ares do Pinhal, Crescer, CASO, others)

▪ Risk reduction approach (NSP, OST-methadone)

Diagnosis

HCV - Diagnosis

Preventable/Curable

▪ Asymptomatic! 20-30% no risk factors

▪ Anti-HCV once in life

▪ Automatic confirmation RNA-PCR

▪ ALT as routine

▪ Priority – identify cirrhosis

Cancer 1-4%/year, varices, sepsis, transplant?

Linkage to Care

Helping a Lot

▪ GAT

▪ Ares do Pinhal

▪ Crescer

▪ CASO

▪ Abraço

▪ Liga Portuguesa Contra a SIDA

▪ AJPAS

▪ Fundação Portuguesa a Comunidade Contra a SIDA (CAOJ)

▪ SER+

▪ Casa Jubileu 2000

▪ SOS Hepatites

▪ Outras…

31-41%

Complex > Simplex

▪ Setting Hospital

▪ Anti-HCV

▪ PCR hospital

▪ Fibroscan, etc

▪ Some Barriers

▪ Setting Local

▪ Anti-HCV rapid

▪ PCR local

▪ Fibroscan portable

▪ No Barriers

8 weeks DAA pangenotypic, safe, no Ribavirin

Pharma

NGO

Patients

Associations

Peers

Tests

HCV

NursesSocial

work

Prisons

Justice

Liver

Tx

DGS

Infarmed

SICAD

NHS

MOH

Person

HCV

pharmacists

ACSS

GPs Doctors

RR

OST

NSP

media

Parliament

Data

Registries

Universities

Futuring

cure, elimination, cure

▪ We want? Political and social decision

▪ Public Health National plan (executive, inclusive, global)

▪ Health and Justice Restauratives

▪ HCV is not only PWID (the stigma)

▪ HCV is liver, cirrhosis, risk of cancer (ad aeternum)