Challenges for health care providers : From

Challenges for health care providers : From patients to policy PD Dr. med. Jan Fehr Infectious Diseases and Hospital Epidemiology University Hospital Zurich Hepatitis – the Elimination of a Viral Disease Zurich 31.Oct.2016 Best care for our patients Challenges for health care providers ! To oﬀer treatment to all (FOPH limitation) ! Health insurances hesitant to reimburse (fatigue, extrah…) ! Support patients rejected for treatment ! Swissmedic label vs. FOPH limitation ! Diﬃcult to treat situations: ! Treatment failures ! Interactions ! How to address transmission/reinfection? ! Fast evolving ﬁeld (mistakes harmful and costly) What can experts do? Overcoming challenges Guidance for HCP Research Policy Expert opinion statement Case based discussions Knowledge gaps: Currently observed epidemic The Swiss HCVree Trial Dialogue with diﬀerent stakeholders Fed. Com. Sexual Health Support Swiss hepatitis Strategy HCP = health care providers Guidance for HCP Incident HCV infections by transmission route in the Swiss HIV Cohort Study. Changing epidemiology Wandeler et al. Swiss Med Wkly. 2015;145 Changing epidemiology: Reasons? Danta et al. Curr Opin HIV AIDS. 2011;6(6):451–8. Braun D, Hampel B, Béguelin Ch, Stoeckle M, Conen A, David H, Flepp M, Rougemont M, Delaloye J, Schmid P, Hoﬀmann M, Kouyos R, Günthard R, Nicca D, Boeni J, Rauch A, Fehr J Research Questions addressed: ! Prevalence of ongoing HCV infection in MSM ! Better understand the MSM-‐HCVepidemic (where/how acquired) ! Evaluate HCV treatment uptake ! Impact of a HCV test, treat, cure and counselling strategy on the postintervention HCV prevalence in this population ! Feasibility/acceptability of behavioural intervention to prevent reinfection (Nicca D, Schmidt A, Künzler P et al.) Drugs and behavioural intervention Current status Oct 2016: 103 patients under treatment, well accepted, no failures Breaking the chain of transmission Federal Committee for Sexual Health (Eidgenössische Kommission für Sexuelle Gesundheit, EKSG) Working group 1: Clinics and Treatment Politics ! WG 1 members: Experts/patients from the ﬁeld HIV/ sexually transmitted diseases ! Mandate: Consultative committee for health authorities ! Close collaboration with FOPH Politics Federal Committee for Sexual Health (Eidgenössische Kommission für Sexuelle Gesundheit, EKSG) !  Pleads for universal access to treatment !  Not limited to patient groups or special conditions !  Lower drug prices are a prerequisite -‐> inline with: Swiss Association for the Study of the Liver (SASL), Swiss Society for Infectious Diseases (SSI), Swiss Experts in Viral Hepatitis (SEVHep), Swiss Society for Gastroenterology (SSG) What can experts do? Overcoming challenges to optimally care for our patients Guidance for HCP Research Policy Expert opinion statement Case based discussions Knowledge gaps: Currently observed epidemic The Swiss HCVree Trial Dialogue with diﬀerent stakeholders Fed. Com. Sexual Health Support Swiss hepatitis Strategy HCP = health care providers

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