INF ECT ION PR EVENT ION & CONT ROL
Driving England’s fight to eliminate Hepatitis C
Professor Steve Ryder, Chair of the Hepatitis C Coalition, is calling on all those involved in the patient pathway to help find the estimated 50% of people with chronic hepatitis C who are unaware of their status, as well as those who have been tested but remain untreated.
In January 2018, NHS England took the ambitious and welcome step of announcing that it was aiming to eliminate hepatitis C in England by 2025. The UK Government had already signed up to the World Health Organization’s targets to eliminate hepatitis C by 2030, so this was a strong statement of intent from the NHS, looking to go one better than the WHO and make England the first country in the world to eliminate the virus. The means by which the NHS planned to achieve elimination were unprecedented in terms of scale and approach. NHS England entered a procurement process with three pharmaceutical companies who manufactured the game-changing direct acting antiviral medicines (DAAs) in order to reach an agreement on supply of medicines. However, the discussions between NHS England and industry also included working out ways in which the companies themselves would work directly towards the elimination effort.
The negotiation that went into securing the three year deal was hailed by Sir Simon Stevens as “sophisticated and unashamedly rigorous”, and the end result was nothing short of ground-breaking. Each company was awarded a share of the market while being tasked with taking forward programmes to improve diagnosis and linkage to treatment of people with hepatitis C. This was a totally new way for the NHS and industry to collaborate and provided, for example, a series of intensive test and treat sessions in the prison environment, partnering with prison health providers and the third sector, and projects focused on needle exchange and community pharmacies.
The collective approach to the elimination has been inspiring. NHS England continues to affirm its commitment to achieving elimination by 2025 and is very confident of reaching this target. It is remarkable to think
AUGUST 2020
that a disease can go from being discovered, named, cured and eliminated over the course of a clinical career. Yet, such is the case with hepatitis C. Early in my medical career, hepatitis C didn’t even have a name, and the interferon-based treatments that were eventually developed to treat it were ineffective and caused unconscionable side effects. It would only be a matter of decades before new DAAs came onto the scene and the whole landscape of possibility shifted, we now have the tools to move from discovery of hepatitis C in the 1980s to eliminating it as a major human disease over the course of the next five years. While this is all very positive and decisive, a concerted effort is needed from all those involved in the patient pathway to help find the estimated 50% of people with chronic hepatitis C who are unaware of their status, as well as all those who have been tested but remain untreated. In
2015, 22 operational delivery networks (ODNs) were created across England to help manage hepatitis C services at a local level. These ODNs will play a crucial role in implementing the elimination deal, working alongside industry and key partners on the various projects.
It can be remarkable how little hepatitis C is understood. It is a blood-borne virus (BBV) that is sometimes known as the ‘silent killer’ because it often has no symptoms until the liver is very damaged and, if left untreated, it can cause liver cancer and death. Now it can be easily treated and cured by simply taking oral medicine for a few weeks. As with HIV, there is still a significant amount of stigma attached to being diagnosed with HCV. There’s also a lot of misinformation: many people I speak to don’t know that it is curable, and don’t know what the risk factors are. While the majority of cases arise through injecting drug use, there are other risk factors
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