To mark World Hepatitis Day on Sunday, the Clinical Chair of NHS England’s Hepatitis C (HCV) programme and the Chief Executive of the Hepatitis C Trust look at how an innovative new partnership is accelerating elimination of HCV in England.
The long walk to elimination of the Hepatitis C virus began over three years ago with the licensing of effective all oral therapy.
England was one of the first countries to introduce treatment for patients with advanced liver disease and we have already seen the benefits of this approach with a reduction in the number of people with advanced cirrhosis and a remarkable fall in the waiting list for liver transplantation.
Over the last three years more than 40,000 patients have been treated for their infection and we know that over 95% are now virus free, meaning over 38,000 people have been spared the disabling effects of HCV.
NHS England is now picking up the pace and our walk to viral clearance is becoming a gallop with ambitious targets to ensure HCV is no longer a public health problem within the next few years.
The early HCV programme involved a close collaboration between NHS England, patient organisations and the pharmaceutical industry, who made drugs available prior to licensing. NHS England entered into an innovative new deal with three major pharmaceutical companies, Gilead, MSD and AbbVie, who have agreed to work together to identify and treat large numbers of infected people.
A key component of the new work programme is a close working relationship with the Hepatitis C Trust who will work with NHS England to find and treat people with HCV. Throughout the country, teams of Hepatitis C Trust trained peer volunteers – people with lived experience – will help local treatment groups identify and engage high risk individuals and provide them with the support and help they need to access effective care.
The NHS is a massive organisation and for those communities who come less frequently into contact with its services, such as homeless people, access to support can be more difficult. In collaboration with pharma, local NHS treatment services will partner with organisations that deliver services to vulnerable and seldom-heard communities.
Enhanced testing and treatment will be provided to the many thousands of people currently using community-based drug support networks. These new investments will expand access to care and, with increased PHE monitoring, we will generate a virtuous circle of improved testing, increased access to care and better monitoring of outcomes.
HCV is not just an infection of people who currently, or previously, inject drugs. People who received healthcare abroad, including childhood immunisations in people born outside Europe remain at risk of infection. Working with pharma, NHS England will link to general practices and using bespoke computer algorithms identify and alert people who may be at risk of infection. Informing people of their possible risk for HCV will allow them to access testing and, if required, treatment to protect them from cirrhosis and liver cancer.
People in prison are often at high risk of infection and this programme will also help eliminate HCV across the prison estate. With a robust reception-testing protocol in place, whole-prison testing will ensure all people at risk of infection are tested and treated. Partnership working with HMPPS, NHS England, health and substance misuse providers, pharma and The Hepatitis C Trust’s peers will be critical to the success of this initiative.
The advent of effective therapy for people with HCV gives us an opportunity to eliminate a major cause of disease and liver cancer, with enormous benefits for everyone – the predicted reduction in liver cancer following the HCV elimination programme will free up resource that can be directed to other important health care initiatives.
The new partnership will allow us to accelerate our plans and in the first few weeks we have already seen an increase in patients being tested and treated.
There is still some way to go but the elimination programme gives us hope that within the next few years we will be able to make history and declare the end of HCV in England.
- We will be running a pop-up university session at this year’s Health and Innovation Expo being staged at Manchester Central entitled ‘Reaching the unreachable – eradicating Hep C’ (11.15am-12.15pm on Thursday 5 September) which will be an interactive session for interested stakeholders. Head to the NHS England website to register and book onto the session.