last year has been incredibly tough for everyone , but it ’ s been inspiring to see how different organisations have come together on this issue despite the pandemic ,’ London mayor Sadiq Khan told the London Joint Working Group on Substance Use and Hepatitis C ’ s ( LJWG ) annual conference – an online event this year . Just one example had been the ‘ enormously successful initiative to offer blood-borne virus testing to homeless people housed as part of our Everyone In scheme ( DDN , September 2020 , page 6 ), which spread awareness about the virus and the treatments available ’.

STORES OF HOPE While the situation was still ‘ incredibly challenging ’, said event chair Vicky Hobart – the Greater London Authority ’ s ( GLA ) head of health – there were ‘ real stories of hope ’ in what could be achieved with effective joint working . The Routemap to eliminating hepatitis C in London ( DDN , May 2020 , page 10 ) steering group had continued to meet , while the initiative to roll out BBV testing for homeless populations in temporary accommodation had been ‘ a flagship moment ’.

More than 1,000 people had been tested – 7 per cent with active infections – and more than 40 had already started treatment , she said , with partners now looking at how this approach could be applied to other settings . Future priorities

would include multi-morbidity testing and diagnosis , opportunities for co-commissioning and ‘ real efforts and pressure towards faster testing and turnaround of results ’.

WORLD LEADER London had been a world leader in its response to hep C , chief executive of the World Hepatitis Alliance , Cary James , told the conference . The alliance had launched a survey to measure the impact of the COVID crisis , with responses from more than 30 countries . ‘ Just about everyone said that their services had been interrupted , but everyone was talking about how they ’ d been working to overcome these barriers – that shift was really inspiring to see .’

While Eastern Europe had reported significant problems in terms of people being able to access services , it was far less of an issue in the west , he said . ‘ People and organisations in London really were leaders in that . Even before the COVID crisis , London was a leader globally in terms of its response to hepatitis C – the routemap being launched was a very strong indication of that – and what ’ s happened since COVID has hit has really reinforced it . We always hold up the great work being done here , especially around peer-to-peer services and the huge role community has in making elimination a reality . It ’ s something that ’ s really helping to educate the world .’

Globally , however , stigma remained a significant challenge , he said . ‘ There ’ s generally a lack of compassion for people living with

viral hepatitis . On paper , hepatitis elimination is such a no-brainer , but there ’ s a lack of empathy from the people who have to pick up that elimination plan and give it to their finance minister to pay for it . That ’ s one of the biggest challenges we face .’

DEVASTATING IMPACT Public Health England ( PHE ) was about to publish a document showing the pandemic ’ s ‘ devastating impact ’ on testing , said PHE consultant epidemiologist Dr Emily Phipps . ‘ We saw a huge drop-off , particularly in the early days of lockdown .’ While this was the case across all settings , drug services had been hardest hit , and despite immense efforts from the Operational Delivery Networks ( ODNs ) treatment numbers had also fallen . ‘ But without those efforts they really would be rock-bottom – so the ODNs really are to be commended ’.

In terms of the impact on people who inject drugs , there had also been concerns around people being able to access injecting equipment and substitute medication , as well as ‘ reported changes in risk behaviours ’, she said , with one in six people surveyed by PHE reporting injecting more frequently .

‘ But despite all the doom and gloom we ’ re still seeing a reduction in cases , and there are some very exciting numbers coming out of London in particular ,’ she continued . ‘ But as we come closer to elimination it ’ s going to become even harder to identify people remaining to be tested and treated ,’ and optimising available data

‘ The last year has been incredibly tough for everyone , but it ’ s been inspiring to see how different organisations have come together on this issue despite the pandemic .’

Sadiq Khan

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