Substance Misuse Outpatient Unit (SMOPU) within Sedqa aims to decrease transmission of the viral disease and reduce mortality for infected clients

World Hepatitis Day is marked today. The World Health Organisation (WHO) chose this date because Baruch Blumberg, who discovered the hepatitis B virus, was born on this day. He also developed the test to detect this virus and the vaccine against it. He won the Nobel Prize in 1976.

This year’s motto chosen by WHO and partners is ‘Hepatitis Can’t Wait!’, highlighting the importance of addressing the impact of such an infectious disease. There are five main types of viral hepatitis which are hepatitis A, B, C, D and E. It is estimated that about 290 million people around the globe are infected with viral hepatitis. Unfortunately, not all of them are aware they are actually infected due to various reasons: they may have no symptoms or they did not take a blood test.

Being unaware that one is infected with hepatitis may lead to complications and lost lives. Hepatitis B and C are more common among people who inject drugs (PWID) due to sharing of needles, syringes and other equipment used  since this exposes them to infected body fluids from other infected people. PWID are more likely to practise risky behaviour involving drugs due to their decreased capability of making appropriate judgements while under the effect of drugs and alcohol.

There are different types of hepatitis and they are transmitted differently.

Hepatitis A is generally transmitted through contaminated food or water but it can also be transmitted sexually. This can be prevented through vaccination.

Hepatitis B is transmitted through infected body fluids such as blood, semen and from mother to child during birth. It can be prevented through vaccination.

Hepatitis C is transmitted through infected body fluids, especially among people who inject drugs and share needles and syringes. No vaccine is currently available.

Hepatitis D is transmitted if the person is already infected with hepatitis B. If a person is vaccinated against hepatitis B, the person is also protected against hepatitis D.

Being unaware that one is infected with hepatitis may lead to complications and lost lives

Hepatitis E is generally transmitted through contaminated food and water and is generally common in developing countries due to poor water and food sanitation.

The aim of the Substance Misuse Outpatient Unit (SMOPU) within Sedqa is to decrease the transmission of viral hepatitis, prevent new infections and reduce morbidity and mortality for clients who are infected. Medical staff at the SMOPU is working constantly to offer holistic support and quality care. Blood tests are offered to all clients attending the clinics to check their hepatitis status.

During 2019, 184 clients tested positive for hepatitis C and one tested positive for hepatitis B. Pre- and post-testing counselling regarding viral hepatitis is offered to our clients. Through early detection of the viral hepatitis, the risk of developing liver cancer and/or cirrhosis is decreased, hence improving the quality of life of our clients.

The SMOPU offers vaccination against hepatitis B on the spot as required. Hepatitis B vaccination is offered onsite since it increases greatly the compliance among clients, hence increasing their chance of getting vaccinated. In this group of population, having a one-stop shop service highly increases compliance. This follows the recommendation by the WHO that incentives to increase uptake of hepatitis B vaccination among this group should be encouraged and implemented.

It also recommends that clients are offered the rapid hepatitis B vaccination regimen. Over these last three years, circa 100 patients were vaccinated on site at the SMOPU against hepatitis B. Unfortunately, due to COVID measures, the vaccination process was interrupted, hence the low figures.

Clients who test positive for hepatitis C are also referred for hepatitis C treatment and other necessary interventions as required. The treatment is in tablet form for approximately 12 weeks. It is highly effective and clears the infection in more than 90 per cent of the patients. The team at the SMOPU and the infectious diseases team at Mater Dei Hospital work closely to offer a seamless service as much as possible to increase hepatitis C treatment compliance and offer the necessary support.

During their visits at the SMOPU, clients are also offered information regarding harm reduction and prevention measures with regards to viral hepatitis infections.  Distribution of syringes to people who inject drugs from health centres helps decrease the risk of transmission of viral hepatitis, especially C and B, among this population.  Medical and paramedical staff, including social workers, also offer mental health support through onsite mental health clinics held by two psychiatrists specialised in addiction.

The free hepatitis C treatment offered has been a ray of hope as it has helped decrease its morbidity and mortality and control its incidence and prevalence rates in the Maltese islands.

Cristina Micallef is public health specialist and works at the Substance Misuse Outpatient Unit (SMOPU) within the Foundation for Social Welfare Services.

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