The NHS is on track to eliminate Hepatitis C by 2025 thanks to a pioneering drug deal and a concerted effort to find people at risk, which is helping dramatically cut deaths five years ahead of global targets.
Following a five-year contract worth almost £1bn to buy antiviral drugs for thousands of patients, deaths from Hepatitis C – including liver disease and cancer – have fallen by 35%. That improvement in outcomes means the NHS has exceed the World Health Organisation’s target of 10% by more than three-fold, putting England in pole position to be among the first countries in the world to eliminate the virus as a public health concern.
But securing new treatments is only one part of the success story. Through dedicated ‘find and treat’ programmes, delivered in partnership with charities like St Mungo’s, the NHS has been successful in driving down cases of Hep C amongst vulnerable communities. People who have experienced homelessness often do not have regular contact with health services, and as a result suffer from worse health outcomes than the general population. The NHS is working with partners to ensure no one is left behind in the fight against Hepatitis C, and as part of the outreach programmes, teams have been working together to provide same-day screenings for people who have been historically hard to reach and treat. Those patients who test positive are then supported to access and complete a full course of treatment.
Sara Hide, a Hepatitis C Co-ordinator at St Mungo’s in Oxford said: “People who’ve experienced homelessness are at a higher risk of contracting Hepatitis C. This can be due to substance use but also sharing toothbrushes, razors and other general lifestyle factors associated with sleeping rough. The NHS were looking for a way to reach more vulnerable marginalised groups and as a result commissioned a joint venture between Find & Treat and St Mungo’s to work with clients experiencing homelessness.
“With treatment for Hepatitis C now less invasive – a course of medication for 8-12 weeks – we’ve seen an uptake in people responding to our screening services. We also screen for other conditions at the same time to identify clients that might need extra health support.”
The ground-breaking NHS initiative on Hepatitis C has helped find and cure 70,000 people of the potentially fatal disease, and drastically reduced the number of people seeking liver transplants due to Hepatitis C. Within six years, the number of people seeking liver transplants due to the virus is down by two-thirds and the number of annual registrations for a liver transplant in patients with Hep C related diseases reduced from over 140 per year to less than 50 per year in 2020.
This figure is expected to be even lower in 2022 and the NHS is now on track to eliminate Hepatitis C five years before the WHO’s overall 2030 target. People in the most deprived communities have seen the biggest benefit, with 80% of treatments provided to the most deprived half of the population.
Children in deprived communities have also benefited significantly. Since the rollout of the pioneering NHS plan to treat children for Hep C last year, more than 100 children received infection-curing antivirals, with 90% of treatments given to the 40% most deprived children. This puts the Hep C elimination programme at the forefront of the NHS’ drive to reduce health inequalities, which calls for specific action to address the poorer health outcomes of children in the 20% most deprived areas. Hundreds more children are set to benefit in the coming months and years.
National Director for Specialised Commissioning at NHS England, John Stewart said: “The Festive period and the cold weather often brings into greater focus the challenges for people experiencing homelessness and we’re pleased that our Hepatitis C programme, working with incredible partners like St Mungo’s, is helping to meet the healthcare needs of many of those individuals.
“On multiple fronts, the NHS is showing international leadership and using its commercial capabilities to not only lead the way in Hepatitis C treatment, but also in tackling HIV, working to eliminate cervical cancer and incentivising the development of new antibiotics to fend off the risk of antimicrobial resistance”.
An NHS screening programme launched in September this year is enabling up to 80,000 people unknowingly living with Hep C to get a life-saving diagnosis and treatment sooner by searching health records for key Hepatitis C risk factors, such as historic blood transfusions or those with HIV.
NHS England has worked with drug companies to identify and treat people who may be unaware they are living with the virus, including people experiencing homelessness and individuals with mental health problems. The initiatives – working with local health services, councils and voluntary groups – find potential patients, test for infection and provide treatment to those who need it.
NHS England National Medical Director, Professor Sir Stephen Powis, said: “The NHS is leading the world in the drive to eliminate Hepatitis C and save thousands of lives, while tackling a significant health inequality in the process. Thanks to targeted screening and because the NHS has a proven track record of striking medicine agreements that give patients access to the latest drugs, we are on track to beat global targets and become the first country to eliminate Hepatitis C by 2030 – which will be a landmark achievement.”
Health Minister Lord Markham said: “We are paving the way for the elimination of hepatitis C, with England set to be one of the first countries in the world to wipe out the virus. I’m grateful to NHS staff and our partner charities like St Mungo’s for the fantastic progress that has been made so far – deaths and prevalence of the virus have fallen consistently thanks to improvements in diagnosis and access to treatments.
“This is another example of the NHS being at the forefront of tackling serious diseases, through swiftly procuring the best treatments and tackling inequalities through targeted screening.”
Rachel Halford, CEO of the Hepatitis C Trust, said: “We are delighted to be a part of this unique elimination deal and work alongside NHS England to find, test and treat people most at risk of contracting hepatitis C. Through our peer-led programmes of work, people who have had and recovered from hepatitis C have been empowered to lead the way and help save the lives of thousands of others by supporting them into treatment. No one needs to die today from hepatitis C; it’s now so easy to get tested, get treated, and get cured.
“The progress that has been made towards elimination is truly astounding. We now need a final concerted effort to make sure we reach all those that may be affected and reach elimination. Investment in a national campaign to improve public awareness of hepatitis C to reduce stigma and encourage people who may have been at risk to get tested is paramount.”
Hepatitis C is a blood borne virus which, left untreated, can cause liver cancer and liver failure. It usually displays no symptoms until the virus damages the liver enough to cause liver disease. Other associated symptoms include fatigue and difficulty concentrating, and Hepatitis C is also linked to cardiovascular disease, mental health issues, kidney disease and musculoskeletal pain.
Hepatitis C is preventable, treatable and for most people, curable. Effective antiviral drugs can cure more than 95% of people, with minimal side effects, which means that it can be eliminated. Quick and free confidential testing and treatment is available to all patients on the NHS.