The global race to eliminate hepatitis C is picking up pace and urgency. In England, we stand a strong chance of winning ‘gold’ due to the wide-ranging reach of NHS England’s Hepatitis C (HCV) Elimination Programme.
Since 2015, the programme has worked tirelessly with partners in the government, charitable and pharmaceutical sectors to deliver a series of world-leading initiatives to eliminate hepatitis C before the World Health Organization (WHO) goal of 2030.
On World Hepatitis Day 2022, we are reflecting on the impact of the programme which has been executed in three phases – the first focussed on people at imminent risk of dying, the second targeted those at greatest risk of passing on the virus and the final phase will involve engaging with people who are not at immediate risk and are unaware of their infection.
The race so far
The first two phases of the programme have been an extraordinary success. Recent data from the UK Health Security Agency (UKHSA) has shown that the initial drive to find and treat people at high risk of death from hepatitis C has led to a dramatic 35% reduction in deaths (from 482 per year to 314 per year). Furthermore, the programme has delivered a remarkable 52.9% reduction in the number of liver transplants since it was established in 2015.
The second phase of the programme saw an unprecedented collaboration between NHS England and the pharmaceutical industry launched in 2019. This genuine partnership working between the NHS, Gilead, AbbVie and MSD has led to a series of jointly funded ‘elimination initiatives’ that have focussed on getting curative treatments to all those who need them.
Successful elimination initiatives have taken place in community addiction services, allowing people who were reluctant to attend conventional health care settings to receive testing and treatment in an environment of their choosing.
NHS England also established treatment services in health and justice settings, which saw all new prisoners offered hepatitis C testing. Since last year’s World Hepatitis Day, 25 prisons in England have achieved ‘micro-elimination’ status by testing over 95% of their population, as a result of these initiatives.
Close collaboration with the Hepatitis C Trust continues to see a network of people with lived experience of hepatitis C support people in the community to be tested and access treatment. Known as ‘peers’, they have increased the number of people who have received treatment by 12% when compared to models without the peers.
Going for gold
We are now moving into the final phase of the elimination programme which involves identifying people with a past history of exposure to risk factors who do not know their hep C status. This includes people who have historically used drugs, spent time in prison, undergone a medical procedure abroad, were born in a country with high hepatitis C prevalence or those who received blood or an organ transfusion prior to the introduction of 1991 screening.
Some of these people will be unaware that historical factors put them at risk. Others may be hesitant to contact traditional health services to take a test as they do not want to discuss historic behaviours. GPs therefore can play a crucial role in finding undiagnosed patients by running automated searches of their primary care records to identify individuals at highest risk. Those identified as having historical exposure to risk factors will be contacted proactively to arrange a free, simple hepatitis C test.
For those who want to know their hep C status but may be reluctant to speak to their GP, NHS England will launch a home testing website in autumn 2022. The website will enable the public to order a testing kit for hepatitis C in which they can take a sample for lab testing in the comfort of their own home. The home testing website will play a crucial role in the race to eliminate the virus as it will empower those who want to know their hepatitis C status to order and undergo a test quickly and discreetly.
This final phase of elimination will also see our focus expand onto ‘opportunistic testing’, where we will test people for hepatitis C at the same time they are having blood tests for other purposes such as antenatal screening or in Emergency Departments.
Inevitably, there is remains some uncertainty around the number of people with past, hidden, risk factors for hepatitis C. To address this uncertainty, NHS England will deliver an assessment of 100,000 hepatitis C tests undertaken in primary care and addiction services from autumn 2022. The assessment of the 100,000 test results will enable us to better evaluate the prevalence of hepatitis C infection in the community. This study will provide the certainty required for the final phase of the elimination race.
To date, the programme has made significant progress towards several milestones which has kept us on track to eliminate the virus ahead of 2030. The WHO target of a 10% reduction in hepatitis C related death by 2020 has been exceeded three-fold in England. We have also already met the WHO 2030 interim target of achieving a hepatitis C related annual mortality rate below 2 per 100,000 people. Great progress has been made to meet WHO targets on access to treatment and reducing morbidity. We are now ushering in the final phase of the race which will see testing and treatment extended into the wider community.
With the ongoing support of our partners, we are confident that we have the capacity to treat all of those who remain infected and in the next few years we will be able to make history by declaring the end of hepatitis C in England.
To read more about the risk factors for hepatitis C and how to access a test, please visit the NHS.UK website.
To find out more about NHS England’s HCV Elimination Programme, and how you can support the race to eliminate the virus, please contact us at firstname.lastname@example.org.