"Our goal is to completely eradicate the disease in Amsterdam."

"Sniper killer" hepatitis C has recently become much more treatable. Correlation, the international branch of De Regenboog, is starting a project to eradicate the disease in Amsterdam. Project leader Eberhard Schatz: "This is a very special development."

Hepatitis C must disappear

That you can get HIV from dirty hypodermic needles, most drug users know. That you are ten times more likely to get hepatitis C is much less known. Moreover, that virus is even more contagious than the HIV virus in that it can sometimes survive for more than a week on, say, a needle. Eberhard Schatz is project leader at Correlation, the international arm of De Regenboog Groep. In a large European project, he saw how important it is to better inform people about the risks of hepatitis C.

Schatz: "In some countries, eight out of ten injecting drug users are infected. In the Netherlands, drug users are reasonably well-informed by the GGD, general practitioners and user rooms, but 'our' group of visitors to walk-in centres actually falls a bit outside of that. Then we asked ourselves: what are we as De Regenboog actually doing against hepatitis C? And at that point the answer was: nothing. And we wanted to change that, because we have the care and responsibility for this group."

Info: Hepatitis C

About 28 000 people in the Netherlands are infected with the hepatitis C virus. Their number is difficult to estimate, because many people themselves do not know that they are carrying the virus.

Risk groups are people who have ever injected drugs, people who have had tattoos done under unhygienic conditions and people born in countries where the disease is common and where (dental) doctors do not always work hygienically. Finally, people who had blood transfusions before 1992 were also at risk. Donor blood was not tested for hepatitis C at that time.

The WHO wants hepatitis C to be eradicated worldwide by 2030. For that to happen, however, much remains to be done. It also means handing out injection materials in countries in Africa, Asia and Eastern Europe so that people do not reuse syringes. It is always possible to become re-infected, but it is not expected to lead to a major new outbreak.

Slash killer

Hepatitis C is what you might call a "silent killer," says Hilje Logtenberg van der Grient, who is a physician attached to De Regenboog's new hepatitis C control project.

"The hepatitis C virus is transmitted through the blood, and causes an infectious disease of the liver. Only at a very late stage, ten to forty years after infection, do people develop symptoms. Without a patient realizing it, the liver can become very seriously damaged, resulting in liver cancer or other serious liver problems. It is therefore important to detect people carrying the virus before they suffer from anything. This is better for themselves and their own health, but also for society. As long as they don't know they have hepatitis C, they can infect others unnoticed."

Visitors of Amsterdam walk-in centres are a high-risk group. But how many of them are actually infected is not known. That's why, in this new project, De Regenboog Groep is teaming up with Mainline and the GGD Amsterdam to go down the city's walk-in centres or to map the group and, if necessary, treat them. Schatz: "We don't know if we will detect many or few cases. If it is only a few: all the better. Our goal is to completely eradicate the disease in Amsterdam."

Wonder

After years of preparation - medical tests are not allowed to be done lightly - a project will start in September for which four to five hundred visitors of walk-in centres of De Regenboog, HVO Querido, Salvation Army and Volksbond will be approached. Using a questionnaire, the doctors will investigate who may have been at risk. The GGD can then test these people, and treat them if necessary. For a few years now, there have been new medications for this.

"That new treatment is called a miracle by many people," says Eberhard Schatz. Hilje Logtenberg van der Grient is also very enthusiastic about the new drugs. "Until now, people were given injections for a year, with many side effects. No more than 50% of all treatments were successful. Now a person only has to take tablets for three months, which have virtually no side effects. And the chance of a complete cure is now 95%. After that, the disease is gone. You don't, as with HIV, remain a patient for life. That's really a big breakthrough. This is now the only chronic infectious disease that is truly curable. That also makes it worthwhile to track down all the people who are infected."

Within the project, staff of walk-in centres will also receive hepatitis C training. From now on, an intake interview must already address whether someone has ever been at risk of being infected with the virus. This increases safety for visitors and staff.

How is the project progressing?

The project will begin in September, taking place in 12 walk-in centres in Amsterdam. The entire project will be completed within six months.

De Regenboog Groep, Stichting Mainline and the GGD Amsterdam will provide information about the disease and the risks and take questionnaires. If these show that someone may have been at risk, the GGD can take a saliva test and possibly a blood test. If infected, treatment then begins. The intention is to approach four to five hundred people.

Europe

Correlation is the international division of De Regenboog Groep, but is now working to eradicate hepatitis C in Amsterdam. What exactly is that about? "We initially worked on combating the disease at the European level," Schatz explains. "We took the knowledge we gained in Europe to Amsterdam for this local project. If the results are good, we are going to spread it abroad again. So this is a great example of the added value of international cooperation for De Regenboog."

Text: Brechtje Keulen | Photography: Merlin Michon