Prof. Tim Dare1
1University of Auckland, Auckland, New Zealand
Biography:
Bio to come
Abstract:
There are now effective and funded treatments for hepatitis C with very significant benefits for individuals and communities. In Aotearoa New Zealand, about 3500 people were treated in the 12 months after the treatment became funded in February 2019, but as testing and referral to treatment has worked through people already linked to treatment or in readily identifiable high-risk groups, it has become harder to engage with people to get them to test. Only 500 people were treated in Aotearoa New Zealand the 12 months ending March 2024. It is estimated that about 20,000 people have Hep C in Aotearoa New Zealand but do not know they have it. If we are to secure the benefits of the new treatments and meet a Government commitment to eliminate Hep C by 2035, we must find ways to test more – and harder to reach – people.
One proposal is to add a Hep C test to routine blood tests done in emergency departments. The need for consent is a barrier to this proposal: EDs are unwilling to add a consent process to already demanding workloads and opt–out consent is problematic: Too many ED patients are too distracted, or stressed, or impaired, to make it safe to assume a failure to opt–out signifies consent. In the UK, EDs have (with supporting advice from a Clinical Ethics Committee) introduced a routine Hep C test based on ‘presumed’ or ‘waived’ consent. Is the UK practice ethical and should other countries adopt it?