DDN Sept_2022 September 2022 - Page 16

This article was developed and funded by Gilead Sciences


Despite the disruption brought about by the pandemic , England has made promising strides towards eliminating hepatitis C ( HCV ) in recent years . But if we are to meet our ambitious targets , we must strengthen our efforts . 1

In 2016 , the WHO set out its roadmap to eliminate HCV as a public health threat by 2030 . 2 NHS England gave a more ambitious target of HCV elimination by 2025 , recently amended to ‘ as quickly as possible ’. 3 , 4

Thanks to the efforts of drug treatment service ( DTS ) providers such as Change Grow Live , We Are With You , Turning Point , NHS Addictions Provider Alliance ( APA ), Westminster Drugs Project ( WDP ) and Humankind , England has made impressive progress . However , the COVID-19 pandemic undoubtedly brought about setbacks , and England faces numerous other barriers to effective diagnosis and treatment . 1
These barriers were addressed in a recent conference funded by Gilead Sciences , Hep C Elimination : The Time to Act is Now , which brought together over 300 representatives from DTS providers , patient advocacy groups and public health experts .
FROM TESTING TO TREATMENT ‘ It was very difficult to support people with hepatitis C through the pandemic ,’ says Peter Smethurst of Gilead Sciences , referring to a crisis that threatened the UK ’ s
2030 elimination target . 1 However , thanks to an incredible joint effort , testing rates bounced back . By the end of 2021 , they exceeded pre-pandemic levels . 5 In May 2022 , Gilead-partnered DTS providers carried out 6,418 hepatitis C tests , a new record for the number of tests performed in a single month . 5
That said , treatment levels have plateaued : ‘ We ’ re finding more people but we ’ re not treating more people ,’ Peter notes . For this reason , ‘ our challenge is now to look at patient pathways and reimagine them , so we can treat as many people as effectively as possible ’.
HEPATITIS C ELIMINATION : A SUCCESS STORY Perhaps no one is better placed to advise on how to tackle this challenge than Dr John Dillon , professor of hepatology and gastroenterology at the University of Dundee .
Professor Dillon spearheaded an award-winning project that eliminated hepatitis C in Tayside – the first region in the world to do so . 6 , 7 In his keynote speech , he shared NHS Tayside ’ s path to success .
Most importantly , he says the focus must be on turning national strategies into action . ‘ It doesn ’ t
matter what the strategies say ,’ he says . ‘ Just make sure they happen .’ With this commitment to action in mind , he urges people to think critically about their testing strategy . Repeatedly testing where you have always tested , where you find no one new , should lead you to seek new patients in new places .
He also stresses the importance of testing people in familiar surroundings , however . ‘ Having to go somewhere new and strange makes a new set of barriers and fears .’ Instead , if those at risk of having hep C accept a test in ‘ places they are familiar with , where they have trusting relationships ,’ they ’ ll feel safer coming back for treatment if they do test positive .
‘ People have experience of stigma in using health services , it adds to the fear of engagement with new services ,’ he says . ‘ We must break that down by bringing services to surroundings and venues familiar to the people we are trying to reach .’
He then lays out the five patient pathways Tayside used to get high numbers of people tested and treated : primary / secondary care settings , pharmacies , drug treatment centres , prisons and needle exchange points .
‘ Each pathway is equally
important ,’ he says . Even though more testing happens in primary and secondary care settings , a higher proportion of positive cases are found through community testing . In Tayside ’ s GP practices , 3 per cent of all tests were positive , while at needle exchange points , this figure was 26 per cent . 8
Finally , Professor Dillon says we must give members of the community the tools to test and prescribe themselves . For him , dry blood spot testing – a blood test for hepatitis C that requires a simple finger prick – ‘ makes the biggest difference so people don ’ t have to travel to their test ’ and we can ‘ reach those we otherwise wouldn ’ t reach ’. Tayside is a glowing reminder that hepatitis C elimination can be achieved .
Professor Graham Foster , national clinical chair for NHS England ’ s hepatitis C elimination programmes , says that while there ’ s a ‘ narrow line between forcing and persuading ’, the key is giving people a choice and being persistent . ‘ People have the right to say “ I don ’ t want this ”, but saying “ no ” today doesn ’ t mean you ’ ll say no next year or the year after .’ He encourages service providers to offer the same treatment to everyone : ‘ We want services to meet the needs of