NHS England recently announced that the country is on track to eliminate hepatitis C by 2025, five years ahead of the World Health Organization 2030 target. It also said that the country’s ‘pioneering’ elimination programme has helped find and cure more than 70,000 people of this potentially fatal virus.
This means that England could become one of the first countries to eliminate the virus – a real example for the rest of the world and for other areas of public health. But with 74,000 people in England still believed to have the virus and current funding for the programme requiring renewal in April 2024, it also means we must not rest on our laurels in these crucial two years.
Earlier this year HCV Action – a network coordinated by The Hepatitis C Trust – released Taking the initiative: how England is eliminating hepatitis C, a report exploring the elimination programme and some of the main initiatives that have been developed under it. These have included efforts by NHS bodies, voluntary sector organisations and pharmaceutical industry partners to find, test and treat people in community settings, the criminal justice system, primary care, drug services, emergency departments and more.
A key finding has been the widespread value of peer-to-peer workers and volunteers with lived experience of hepatitis C or substance use in finding and supporting people with hepatitis C. Figures from The Hepatitis C Trust show that since the current programme started in 2019, 29,000 people at risk of hepatitis C were tested and 3,800 were supported into treatment thanks to this kind of work. In recognition, health minister Lord Markham recently commented that, ‘Almost every [hepatitis C] elimination initiative that NHS England manages and commissions…has peer involvement. NHS England consistently finds that people with lived experience are excellent advocates and are crucial in developing therapeutic alliances to support people into testing and treatment who may have felt excluded from traditional healthcare and other settings.’
The UK Health Security Agency (UKHSA) cites injecting drug use as a risk factor in most hepatitis C cases. This is why collaboration in drug treatment services has been developed under the programme to help cut across commissioning boundaries, simplify pathways and bring together service providers that often find themselves in competition. A Hepatitis C drug treatment services provider forum was established to strengthen data sharing across organisations, improving access to treatment for people using services. Initiatives during the COVID-19 pandemic saw drug treatment services adapt to include home testing, remote monitoring and targeted testing of homeless populations, and these types of efforts recently saw the provider forum receive a Health Service Journal award for its ‘outstanding dedication to improving healthcare and effective collaboration’.
However, with the programme having found many of the more reachable cases, in the final stretch we’re now seeing additional work to find outlying cases. The HCV Action report touched on NHS England plans for an online portal where people can order a discrete and remote home testing kit. This scheme – aiming to broaden access to treatment for people neglected by, or physically further from, services – has since been launched and is accessible at hepctest.nhs.uk/.
With funding for the elimination programme coming to an end at the end of March 2024, a new strategy will be needed to ensure that the work so far doesn’t go to waste, and that elimination is achieved by 2025. This is why The Hepatitis C Trust’s message for World Hepatitis Day 2023 on 18 July will be ‘don’t miss the target’, to keep up momentum and to ensure that years of work and £1bn of investment are built upon.
Even beyond this, we’ll need strong and vigilant harm reduction measures – such as needle and syringe exchange programmes and regular testing of people from higher-risk backgrounds – to prevent new infections, alongside continued commitment to testing and treating those at risk. This will safeguard the legacy of England’s hepatitis C programme, ensuring that we achieve elimination and sustain it for everyone thereafter.
Elliot Bidgood is policy and parliamentary adviser for The Hepatitis C Trust and Coordinator for HCV Action.
Hepatitis C – The time to act is now (July 2023): Resources and videos on the campaign for Hepatitis C elimination.
News (15 May 2023) NHS makes free confidential hep C tests available