Doubling Down

With World Hepatitis Day on 28 July, now is the time to redouble our efforts towards hepatitis C elimination, says Rachel Halford.

Rachel Halford, chief executive officer at the Hepatitis C Trust
Rachel Halford is chief executive officer at the Hepatitis C Trust

World Hepatitis Day this year will be unlike any other we have celebrated before. Hepatitis C continues to have a huge impact on people who inject drugs, with the latest statistics showing the rate of new infections among injecting drug users remains worryingly high. The surge of activity we have seen since last summer when NHS England signed an elimination deal with the pharmaceutical industry – not only to provide medication but also to commission case-finding initiatives – has largely come to a halt as a different virus has taken centre stage.

As with almost all other areas of healthcare, the impact of COVID-19 on services providing hepatitis C treatment has been sudden and dramatic: nurses and doctors were re-deployed overnight, clinics were cancelled, most testing ceased and new treatment starts were generally delayed. HCV Action, a network for professionals working in hepatitis C coordinated by The Hepatitis C Trust, found that around one quarter of the 22 hepatitis C treatment networks (operational delivery networks) were only able to treat patients already on their registers or no cases at all at the end of May, even as clinics began to recover.

Understandably, as many doctors and nurses have had their time diverted from clinics to wards in order to provide much needed additional capacity, some areas were under greater strain than others. Despite these difficulties, a number of services have demonstrated phenomenal creativity and determination to continue to help people. Many of The Hepatitis C Trust’s peer-to-peer support staff and volunteers have been going into temporary accommodation across the country to test people who had been living on the streets. This brilliant partnership working between NHS trusts, other charities, alcohol and drug services, and the hotels and hostels themselves has allowed many hundreds of people who had been rough sleeping to be tested and referred on to treatment – engaging a population for whom the traditional treatment model is often not accessible.

COVID-19 has laid bare the extent of health inequality in this country. In England, people living in the most deprived areas are around twice as likely to die from COVID-19 compared to those in the least deprived. Hepatitis C likewise impacts disproportionately upon the most vulnerable in our society – almost half of the people with hepatitis C who go to hospital come from the poorest fifth of the population.

As health services begin to recover from the strain of increased admittances to intensive care, it is essential we re-focus efforts to address those disease areas which predominantly affect disadvantaged and marginalised populations, of which hepatitis C is one. With easy-to-take drugs that have a short treatment term and high cure rate there is no excuse for the UK not to meet its commitment to eliminate hepatitis C by 2030 – the World Health Organization’s hepatitis elimination goal, which we joined many other countries in signing up to. Progress has been positive on diagnosis and reducing hepatitis C-related deaths, but we have a long way to go before we can viably achieve and sustain elimination.

Even with the persistence of laudable efforts to target those people most at risk of infection, there has been no notable reduction in new transmissions in recent years. Prevention is absolutely vital to achieving elimination and yet currently harm reduction provision does not go far enough, with 36 per cent of people who inject drugs reporting in 2018 that they did not have adequate needle and syringe equipment for their needs, heightening the risk of hepatitis C transmission through sharing injecting equipment. We must ensure people are supported to access needle and syringe exchanges adequate for their needs and so reduce the spread of blood-borne viruses such as hepatitis C.

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The majority of hepatitis C cases in the UK remain undiagnosed, resulting in potentially tens of thousands of people experiencing health complications including liver damage and an increased risk of mortality. This World Hepatitis Day we must applaud services for their incredible hard work and dedication so far, and redouble our efforts to prevent new infections and expand testing and treatment until we have achieved elimination.

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