HEPATITIS C
DOUBLING DOWN
With World Hepatitis Day on 28 July, now
is the time to redouble our efforts towards
hepatitis C elimination, says Rachel Halford
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-topeer
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.
‘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. ‘
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 bloodborne
viruses such as hepatitis C.
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.
Rachel Halford is chief executive
officer at the Hepatitis C Trust
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 11