from the information from the Department of Disease Control By the AIDS and STDs Division last year, it was found that the number of patients “Hepatitis C virus” Worldwide, there are 71 million people, while Thailand itself has 8pine people and patients are more and more likely to die
The dangers of the hepatitis C virus will cause chronic hepatitis and if left chronic hepatitis for a long time will lead to cirrhosis and ended up becoming liver cancer, which is the leading cause of death. of Thailand as well
That makes Thailand set a goal to eradicate hepatitis. (both B and C) to a minimum by 2030, or in the next eight years, which is also in line with policies from the World Health Organization (WHO).
However, screening for people with hepatitis C may be directed at risk groups first. which one of them is “Group of prisoners”
“The Coverage” volunteered everyone to meet. Dr. Oran Wiwattanachang Specialist in internal medicine, gastroenterology and liver diseases and director of the Medical Education Center, Udon Thani Clinic Udon Thani Hospital to step through the wall to talk regarding the efforts of this “hepatologist” to screen for hepatitis C for “All inmates in Udon Thani Central Prison”
All inmates were screened. All patients were treated
Dr. Oran said that usually in prisons there is a project. “Pansuk correction” that already has an annual screening test for hepatitis C Because inmates are considered a high-risk group. as well as those who inject drugs into the veins male love group tattooed person body piercing Therefore, it is a good opportunity to enter the screening conscientiously.
However, with a project called “Screen All Treat All” All prison inmates will be screened with blood drawn. Because in the past, screening for hepatitis C was only partially screened. This made it impossible to see the full picture of which inmates had or weren’t infected. This project has already started at the beginning of May, from the original expected to start at the beginning of the year. But stuck due to the Covid-19 situation The screening will also include testing for HIV, syphilis and hepatitis B.
“A rough number We screened regarding 4,000 cases, of which 48 were infected,” said Dr Oran.
Then, when the number of patients was known The next step is to bring all the patients into treatment. by taking the drug for 12 weeks, then 3 months following the end of treatment The patient’s blood will be drawn once more to see if the disease has been cured or not, of which 95% of those treated can be cured.
Another image was reflected. is the drug currently used to treat hepatitis C. high efficiency It can get rid of viruses quite well. low side effects and most importantly, available in all rights of treatment because it is a drug that is on the National Essential Drug List or “J (2)”
In fact, not all patients originally had access to this drug. Because the use of drugs on the national list of essential drugs has certain conditions, for example, the patient must have a high fibrosis score at some level. Therefore, it may not be used to treat everyone.
But today’s situation is not like that. When the AIDS and STDs Division considered for Udon Thani Province is the first area In pilot, ‘every’ hepatitis C patient will have access to medicines. That is the starting point for this liver disease doctor. Applying such policies to prison patients for that reason Since he, like the general public, he has hepatitis C. andWhen screening everyone, everyone must be treated.
Dr. Oran emphasizes that early treatment is beneficial for patients. Because when the liver is not infected or inflamed, cirrhosis and liver cancer will not occur. The next point is that it still benefits the inmates in the prison. Because if the patient is recovered, it will not spread to other inmates in the prison. Due to the congestion of prisons or may have other risky behaviors
“When he didn’t have hepatitis C He will not spread to others. and is good for the outside population When inmates treated for hepatitis C recover When leaving the prison to the outside world He also doesn’t take the hepatitis C virus that has been in him and spread it to outsiders,” the hepatologist pointed out.
Go over the prison walls with the system “Telemedicine”
“One joke That is, when I first entered, I would look for the door. Find a way to escape that is constantly chasing. in case there is a problem so that he can run right,” said Dr. Oran, while talking regarding the beginning of working with the inmates. By stating that personally, I would like to thank the Pansuk Correctional Project. that His Highness had mercy on the inmates ready to treat like a normal person And as a citizen, one would like to help a group of inmates. Which is considered a group that society does not pay attention to. Maybe because of some fear or attitude. While in fact he is a member of society as well.
“When I actually entered I feel that the Udon Thani Central Prison is quite orderly, clean, and doesn’t look as scary as the image in our brains,” said the hepatologist. At present, there is no need to look for an escape route anymore.
Moreover, Dr. Oran also stated that usually doctors and nurses are kind to patients. and thought further on how to make it possible for doctors, nurses, others who may not have cared for prison inmates before. to be able to treat patients in prison without the need to enter the prison that is to use “Telemedicine”
for Telemedicine System in Udon Thani Central Prison In fact, it happened regarding 2-3 years before the COVID-19 situation. but is rarely used But when the outbreak of COVID-19 Therefore, it is like compulsory that prevents doctors from entering prisons, and telemedicine is used as the main tool for monitoring the symptoms of prison patients once a month.
At the same time to follow up on symptoms every time The team of doctors and nurses will also educate the patients. because of hepatitis C This does not mean that there will be permanent immunity. But can come back to be once more even following it’s gone It’s worse if you still have risky behaviors. Re-infection may also make the bacteria resistant to drugs.
screening for hepatitis C virus Not yet available to everyone
Dr. Oran also said that in the part of the general public who will be screened for hepatitis C According to the benefits from the National Health Security Office (NHSO), there are 2 groups. The first group is the group with HIV in the body. According to the benefits, they can be screened for hepatitis C once a year.
The next group is the group that does not have HIV in the body, although it can be screened. But to remit that person must be diagnosed with hepatitis. For example, if 100 people have blood drawn and found 5 people with hepatitis C, then only 5 can be withdrawn.
That made this liver doctor I see that the problem lies in the screening of people with hepatitis C. There is no campaign for screening in all Thai people. including the conditions for using the drug from the drug list E (2) as well
“Screen all story for the general public There must be a really active country policy. In order for people to draw blood for the BC virus, if more information is available, policymakers may see the importance of this point,” Dr Oran said.
In addition to the group of prisoners Garbage collectors are another group that the doctor is interested in screening. Because there is a risk of being stabbed by needles or sharp objects during work. Although this group of people already have a blood test. But it can help to see if anyone is infected or not. because if there is, it will be sent to the treatment
Suggest guidelines for community hospitals to dispense medicines
Another thing that Dr. Oran thought regarding to reduce hepatitis C infection. that is, creating a system Guidelines for community hospitals where doctors cannot prescribe this drug. Because the condition of the drug list E (2) states that the doctor has the right to prescribe this drug. Must be an internal medicine physician in liver disease or internal medicine doctors who work for more than 5 years. However, in community hospitals, they are often new graduates. or general medicine physician
“A doctor at a community hospital wouldn’t be able to prescribe this drug. makes when encountering hepatitis C patients He will have to send him to the Udon Thani hospital in order to receive the medicine,” Dr. Oran explained regarding the jam.
When that was the case, a gap was formed. When patients are referred, they may come. or unable to come including travel expenses The reverse was to bring this drug to the community hospital. and dispensing medications to patients without having to travel to the hospital center
“We have to understand and agree with the NHSO that the doctors at the community hospitals will send a patient message to me. In order to determine if this patient is actually compatible with Drug E(2), I would approve and prescribe the drug to a doctor in a community hospital. without the patient having to come to the center hospital,” this liver disease doctor offers a guideline.
In the end, Dr. Oran continued to tell regarding another goal. is to serve as a model for HCV screening for other prisons. Because the Udon Thani Central Prison has shown that it can screen inmates. and able to give medication to all patients The visit or follow-up of patients does not bother doctors or nurses much because there is a telemedicine system which, if it can be adapted to other prisons. It will make caring for inmates in prisons more efficient.