This quarterly newsletter provides a concise summary of developments in hepatitis C for policymakers, clinicians, commissioners, local government, charities and others with an interest in hepatitis C or public health.
Updates will also be included from the Coalition’s diverse membership, which includes patient organisations, professional bodies, clinicians, industry and other interested parties.
Please do forward this newsletter on to anyone who might find it of interest, letting us know so we can track circulation.
NHS England plans to eliminate hepatitis C by 2025
As you will no doubt be aware, back in January NHS England announced that it was aiming to eliminate hepatitis C in England by 2025, five years earlier than the World Health Organization targets. In response, the Hepatitis C Coalition released the following statement through our Chair Professor Steve Ryder:
We welcome this plan to make England the first country in the world to eliminate Hepatitis C by 2025, but there is a long way to go and this deal still needs to be completed.
Some 160,000 people in England are thought to be living with chronic Hepatitis C. It can go undetected for years, during which time it can cause significant damage, including liver scarring, liver cancer and death. Half of those living with the virus are still undiagnosed and just 10,000 of those infected were treated last year – an unacceptably low number.
However, with the right diagnosis and treatment, it is curable and there is now a real opportunity to eliminate the virus. We look forward to working collaboratively with Government, NHS England, Public Health England, and as many wider stakeholders as possible to make this happen.
APPG on Liver Health launches report ‘Eliminating Hepatitis C in England’
The All-Party Parliamentary Group (APPG) on Liver Health published its report ‘Eliminating Hepatitis C in England’ and launched it in Parliament on 20th February. The event took place in the Thames Pavilion in the House of Commons and included speeches from The Hepatitis C Trust Chief Executive, Charles Gore, along with parliamentarians Norman Lamb MP, Virendra Sharma MP, Sir David Amess MP, Baroness Randerson, Baroness Masham and Lord Mancroft.
The result of an inquiry comprising both oral and written evidence from a wide variety of experts on hepatitis C, the report finds that England has a once-in-a-generation opportunity to eliminate hepatitis C as a major public health threat if a national elimination strategy can be agreed.
Drawing on contributions from experts from across the hepatitis C care pathway, the report sets out the challenges to achieving elimination of hepatitis C, including:
- Many of the 40-50% of patients who remain undiagnosed are part of vulnerable populations with chaotic lives, or part of hard-to-reach groups who are out of touch with services and may not consider themselves to be ‘at risk’
- Low levels of awareness and misconceptions about transmission routes among the general public and primary care workers
- Low levels of testing in prisons, despite the implementation of an opt-out testing policy since April 2017
- Funding pressures on local authority services having a negative impact on prevention efforts and testing initiatives
- Overly complex care pathways creating barriers to accessing treatment.
- The introduction of opt-out testing for hepatitis C in substance misuse services, with commissioning contracts stipulating clear mechanisms to hold services to account for failures to meet testing targets.
- Treatment to be universally accessible and available in community settings like drug and alcohol services and sexual health services
- An effective long-term funding deal between NHS England and industry supported by a national elimination plan
- National guidance to be issued on effective implementation of opt-out testing in prisons.
The Hepatitis C Coalition released the following statement about the report:
We welcome the APPG report launch, which demonstrates the collaborative approach and commitment of the whole HCV community to play its part in elimination.
It is now critically important that everyone involved in the pathway takes account of the recommendations of the report. Only with all elements working together will the goal to eliminate HCV by 2025 be achieved.
Drugs, Alcohol and Justice Cross-Parliamentary Group
A meeting of the Drugs, Alcohol and Justice Cross- Party Parliamentary Group took place on 7th March. The session was chaired by Lord Ramsbotham and was very well-attended by representatives from the substance use community, health and justice services and parliamentarians.
The focus of the meeting was centred on advancing an evidence-based approach to drug policy. In addition to speakers from Adfam and the Transform Drug Policy Foundation, the session hosted a roundtable on drug policy from four Police and Crime Commissioners (PCCs) from different locales across England and Wales.
The discussion took in harm reduction measures such as drug consumption rooms, needle exchange programmes and heroin assisted treatment.
Parliamentarians in attendance included Thangam Debbonaire MP, Liz McInnes MP, Grahame Morris MP and Baroness Masham.
The Drugs, Alcohol and Justice Cross-Party Parliamentary Group seeks to focus attention on addiction issues and advocate evidence-based policies, enabling treatment services to save and transform more lives. It published a ten-point Charter for Change, calling on the Government to act.
The Group provides an interface for professional providers of drug and alcohol treatment with parliamentarians from all parties who share an interest in these issues. The Group holds regular meetings in Parliament and is supported by Blenheim, Addaction and the Westminster Drugs Project.
Public Health England publishes ‘Hepatitis C in England 2018’ report
Public Health England published its report on Hepatitis C in England 2018 on 26th March. The report paints a mixed picture of progress on hepatitis C testing and treatment in England. While there has been a sustained fall in deaths from end stage liver disease (ESLD) and hepatocellular carcinoma (HCC), as well as in the number of liver transplants, the report acknowledges that there is still a way to go in case-finding and in re-engaging those lost to treatment.
Here are some of the key statistics:
- Against a background of rising HCV-related mortality that was predicted to increase in the future, the first fall in deaths in more than a decade has been sustained for another year, with a 3% fall in deaths from HCV-related ESLD and HCC between 2014 and 2016. This suggests that increased treatment with new direct acting antiviral (DAA) drugs, particularly in those with more advanced disease, may be starting to have an impact
- Falls have also been observed in liver transplant registrations (43% fall by 2016, when compared to pre-2014 levels) and liver transplants undertaken (25% fall by 2016, when compared to pre-2014 levels) in those where post-hepatitis C cirrhosis is given as the indication for transplant
- From these reductions, PHE surmises that the World Health Organization (WHO) Global Health Sector Strategies (GHSS) target for a reduction in HCV-related mortality of 10% by 2020 looks within reach
- However, only around one half (52% in 2016) of people who had injected psychoactive drugs sampled in the Unlinked Anonymous Monitoring (UAM) Survey were aware of their HCV antibody positive status, and this figure has remained relatively stable at this level over the last decade
- Over the last two decades (1996-2016), there has been a more than fivefold increase in the number of laboratory confirmed reports of HCV in England, with 10,731 reports of individuals testing positive for antibodies to HCV and/or HCV RNA in 2016
- The WHO European Region target of 50% of those with chronic HCV having been diagnosed and aware of their infection by 2020 may have already been met in England, but more work is needed if we are to meet the target of 90% diagnosed by 2030
- Among new receptions to English prisons, levels of testing have been seen to rise from 5.3% in 2010/11 to a provisional 10.5% in 2016/17
- Importantly, the report states that the proportion of PWIDs reporting adequate needle and syringe provision remains suboptimal, with just less than one half (45% in 2016) of those who had injected psychoactive drugs surveyed reporting adequate provision for their needs. Although levels of sharing of needles and syringes have declined from 28% in 2005 to 18% in 2016, there is no evidence of any fall over the last five years. Together these findings suggest that the WHO GHSS call to reduce new cases of chronic HCV by 30% by 2020 and 80% by 2030, represents a significant challenge for health services in England.
The report also makes a number of recommendations. Here are some of the key points:
- PHE to further develop national indicators and tools at both national and lower levels, to help monitor progress towards the WHO GHSS goal to eliminate hepatitis C as a serious public health threat by 2030
- Public health professionals working in local authorities and CCGs to consider including HCV in Joint Strategic Needs Assessments (JSNAs) and subsequent health and wellbeing strategies
- Commissioners of services for PWIDs need to sustain or expand, as appropriate, the current broad range of provision (including opioid substitution treatment, needle and syringe programmes, and patient information) to reduce transmission of HCV
- All stakeholders to continue to produce and disseminate appropriate communications, including resources, national reporting and infographics, to help mark World Hepatitis Day
- Drug prevention services should ensure that testing is sustained or enhanced, as appropriate, among those attending drug services; the use of newer technologies, like DBS testing, that make testing easier in non-clinical settings, should be further expanded throughout England
- Health and Justice to ensure that blood borne virus opt-out testing for new receptions to prisons in England continues to be monitored to inform strategies to further improve the uptake of testing
- Commissioners and providers of drug services to consider blood borne virus opt-out testing
- NHS England to provide treatment data to PHE to enable preliminary assessments of the equity, access, uptake and impact of treatment on the future burden of HCV-related disease in England to inform future healthcare planning and to monitor progress against WHO goals to eliminate HCV as a serious public health threat by 2030.
Professor Steve Ryder in the Telegraph
Chair of the Hepatitis C Coalition, Professor Steve Ryder, wrote an article which was published in the Telegraph. The article follows on from NHS England’s announcement that it aims to eliminate hepatitis C by 2025, five years earlier than the World Health Organization’s target of 2030. It offers a positive call for collaboration in the push towards elimination, and references the APPG on Liver Health report.