HCSA Community Services with support from Gilead Sciences, and Tan Tock Seng Hospital, launch first Hepatitis C elimination initiatives for ex-offender groups in Singapore

27 July 2022

In alignment with the World Health Organization (WHO)’s call to eliminate hepatitis C (HCV) by 2030, HCSA Community Services (HCSA), a charitable organisation that supports ex-offenders, abused teenage girls and single parents, today announced the launch of a targeted HCV elimination programme, a day ahead of World Hepatitis Day 2022.

Founded by HCSA and coordinated by HCSA Highpoint Halfway House, a residential shelter for ex-offenders, the HCSA Highpoint Hepatitis C – Educate, Test, Treat! (ETT) Programme, together with the End-C Programme founded by Tan Tock Seng Hospital (TTSH), aims to provide HCV testing, education, and linkage to care services for high-risk patient groups such as former drug offenders, newly released prisoners, and those in recovery from addiction. The ETT programme is a grant project supported by Gilead Sciences.

In conjunction with the ETT programme, TTSH is currently running a study with HCSA’s participants to validate the reliability and convenience of a minimally invasive point-of-care test (POCT). The POCT would provide a possibility of more convenient and accessible method using a finger-prick blood sample and saliva test. The concept of the POCT is focused on reducing the barriers to testing as it could encourage a person to test frequently and get quick results in 20 to 40 minutes. A positive result will then allow the person to seek confirmatory tests and receive earlier intervention. Confirmed active HCV participants of the ETT programme will also be given oral medication for treatment.

The findings of the ETT programme will be further implemented in the End-C Programme, which aims to gradually treat and screen other at-risk groups. One of its main goals is to ultimately encourage self-assessment of HCV risks amongst the public. The combined efforts of HCSA and TTSH to combat HCV include a newly launched Hepatitis C clinic in TTSH and the setup of a digital resource platform which grants access to education materials and a FriEnd-C Befrienders’ Toolkit to encourage positive HCV patients to complete their treatment journey. The ETT and End-C Programmes, which are running concurrently, will also focus on providing seamless access to treatment for HCV-infected patients. Both the ETT Programme and TTSH study will be conducted over a period of twelve months. Please refer to Annex A for more information.

HCV has often been described as the ‘hidden epidemic’ because new HCV infections are typically asymptomatic until decades later when symptoms develop secondary to serious liver damage. As of this year, the WHO estimates that approximately 58 million people live with HCV worldwide with 1.5 million new infections occurring each year ¹. As the virus is easily transmitted through blood-to-blood contact, HCV disproportionately impacts people who inject drugs. According to the Global Commission on Drug Policy, out of the 16 million people who inject drugs globally, around 10 million are currently living with HCV ².

"Each at-risk patient experiences a different challenge to achieving recovery, ranging from socioeconomic constraints to stigmatisation associated with the mode of virus transmission," says Dr Yew Kuo Chao, Senior Consultant, Gastroenterology and Clinical Hepatology, Tan Tock Seng Hospital. "We hope to drive the elimination of HCV by providing linkage to care for patients and introducing minimally invasive testing and simplified treatment methods. If successful, we hope to expand this service to the wider population and benefit more people in the process."

Without medical intervention, HCV can progress to lifelong chronic liver conditions. Despite the severity of HCV, there remains a general lack of awareness and an attitude of indifference towards liver health in Singapore. According to the recent Liver Index Study conducted by Gilead Sciences, less than half (42%) of the Singaporean general public recognise that viral hepatitis is one of the key causes of liver failure in the world. Furthermore, only 65% of respondents have attended a health screening in the past two years, even though majority (91%) agree that regular screening is essential to maintaining liver health. If left unaddressed, this could hinder public efforts to control the spread of HCV locally.

"The World Health Organization has set a global target to eliminate viral hepatitis as a public health threat by 2030. Through the Liver Index Study, we have identified critical knowledge gaps and attitudes of the general local public towards liver health. Gilead Sciences is working with community partners to support high-impact initiatives which address existing barriers and challenges to HCV elimination efforts," says Stanley Li, General Manager, Hong Kong, Singapore and Malaysia, Gilead Sciences. "Microelimination projects like the HCSA Highpoint Hepatitis C – Educate, Test, Treat! (ETT) Programme, with its focus on high-risk groups for which treatment and prevention interventions can be delivered more efficiently, is a starting point that we believe will translate into more positive impact for local communities."

As part of the combined programme, patients will also be given educational materials and telephone consultations by the Tan Tock Seng Hospital Gastroenterology and Hepatology Department, to assist them in their treatment journey. This is complemented by HCSA’s FriEnd-C Befriender Programme, an integrated support system to guide patients that are HCV positive and ensure that they do not fall out of the programme and complete the treatment journey.

To sustain and drive further education among target patient groups, HCSA will also be conducting educational campaigns through a range of initiatives, including talks at HCSA Highpoint Halfway House and other halfway houses in Singapore.

"As the first halfway house in Singapore to champion and host this first of its kind HCV elimination programme, we are committed to driving awareness and education on HCV among vulnerable groups," said Kim Lang Khalil, Chief Executive Officer, HCSA Community Services. "We are confident that the ETT and End-C Programmes will empower at-risk groups, remove existing barriers to HCV care, and enable all individuals to live their lives to the fullest."

Annex A

The Hepatitis C virus (HCV) infection is a curable disease in this modern world.

Integrity is crucial to ensure continuity of care in the diagnosis and management of HCV patients. This process is easily broken by various barriers preventing a patient from coming forward for testing and receiving treatment. An individual must first recognise the risk factors in this stigmatised infectious disease. Education on HCV transmission mode, its long-term complications and the chance of recovery set the foundation for enabling an individual at risk to get tested and receive treatment early.

In collaboration with HCSA, Tan Tock Seng Hospital (TTSH), initiated a study to identify the barriers faced by people who had used drugs in the past. In the first three months of the study, 65 participants from HCSA Highpoint Halfway House came for enrolment. Of this, 36% had not heard of Hepatitis C, 68% were unaware that it is an infectious disease, and only 38% are aware of its transmission by blood through contaminated instruments during piercing activities.

One of the barriers is the lack of awareness and knowledge of Hepatitis C amongst the incarcerated and socio-economically disadvantaged community. As such, TTSH has developed a digital resource platform for easy access to Hepatitis C related information, and for participants to participate in an anonymised chat with a healthcare personnel. The platform also utilises an online support group led by HCSA to conceptualise this alternative education modality.

In support of the World Health Organisation’s call to eliminate HCV by year 2030, TTSH has recently launched a new bi-weekly Hepatitis C clinic since April 2022 to further encourage a smoother process for HCV positive participants to come for HCV management. To reduce the need for physical presence in the clinic, clinical care is further simplified through telephone consultation by a doctor who will check and review the patient’s medication compliance. TTSH’s Hepatologists also coordinate closely with Pharmacists to ensure treatment aligns with the management plan.

There is also a dedicated support group, whose members assist HCV patients and at-risk groups in acquiring knowledge, supporting their psychosocial challenges and encouraging them to complete their treatment journey. The Fri-End-C Befriender’s Toolkit and educational sessions performed by TTSH have empowered these volunteers who are serving as mentors to at-risk communities. Financial support is also made available for these patients.

The End-C Programme, which is a local initiative founded by TTSH, has been set up with aims to actualise a step-wise commitment to reach out to other at-risk groups of HCV, and eradicate HCV in Singapore by year 2030.

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