B LOOD - BORNE IN F ECT ION
by disturbing trends which indicate that prevention work is declining against positive outcomes in other areas. Indeed, the PHE in England report found that over the last few years the number of new HCV infection remained static and could even have increased in 2018.2
This underscores
the need not to become complacent, and highlights the importance of collaborative action among people involved in the patient pathway to keep up the effort to eliminate the virus.
The current outlook
It seems that keeping the number of new infections under control forms a major part of the current challenge. This is evidenced by PHE, but is also anecdotally a common experience, as evidenced by my own experience as well as that of my colleagues from across the patient pathway. Members of the Hepatitis C Coalition – of which I am Chair, which includes representatives from patient groups, drug and alcohol services and homelessness charities – have all reported encountering a difficulty in stemming the tide of new infections. According to PHE’s Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among PWID: 2020 report, which synonymously surveys people who inject drugs, there has been no decline in hepatitis C transmission in recent years, despite a singular dedication to case-finding initiatives and many more people being tested and treated for the virus.7
There is a clear reason for this: failings in harm reduction policy and implementation. The Hepatitis C Trust is clear that the findings from the UAM Survey show that greater investment is needed in harm reduction.8
This can be a difficult policy
area, because many of the aspects of harm reduction that have been shown to be
There’s no denying the disruptive impact of the COVID-19 pandemic on HCV elimination efforts, but now is not the time to be disheartened. Rather, now is the time to do what we can, to collaborate with all those involved in the patient pathway in order to develop innovative initiatives across England to improve identification, testing and links into care.
effective in reducing harmful behaviour, such as needle exchanges and even safe drug consumption rooms, can be politically controversial, even when their success is evidence-based.
But the WHO targets require a reduction of 80% in new infections by 2030. This may seem like a long way off, and less of an immediate concern, but the static nature of new infection rates indicate that this might end up being a major barrier to achieving the 2025 elimination target that NHS England and its collaborating partners are working towards. This will need to be a priority in our collective approach to making progress towards HCV elimination.
The impact of the COVID-19 pandemic
And that is not the only challenge to overcome. Despite all the positive steps in reducing HCV infections and getting closer to the 2025 goal of eliminating the disease, understandably, over the last few months, the attention has shifted to COVID-19. The fight against hepatitis C has suffered some delays. Before the first national lockdown, we were on a national trajectory to treat
more than 71,000 people living with HCV by 2025. Taking COVID-19 into account, we have had to review this, and our revised aim is for more than 63,000 by 2025.9 When we assessed the situation for
World Hepatitis Day in July 2020, we were confident that the impact of the pandemic on our ability to tackle hepatitis C had not been as bad as it might have been. We had feared that there would be no new treatment courses begun in the first quarter of 2020 due to lockdown, and only 50% in the second, thanks to some innovative thinking by operational delivery networks (ODNs) – the 22 local footprints that deliver HCV care across the country – we have been able to continue, albeit with some variation among ODNs. We still hope to treat around 10,000 people in 2020/21.
Recent successes and future progress
This success is undoubtedly the case because of the collective ingenuity and commitment of all those involved in the patient pathway. Because HCV most often affects marginalised communities, there has always been an element of tenacity required from those of us who work in HCV care to really find patients, get them tested and into treatment. But my ODN in Nottingham had to reaffirm our commitment to getting the hard work done in very difficult circumstances during the pandemic, and we are continuing to do this through the hard winter months, upscaling remote working for example.
There are many other positive examples to draw from the pandemic; innovative ways to reach the undiagnosed population, and clever solutions from across the ODNs. This has been possible because the current circumstances have presented some unexpected opportunities to improve outreach with vulnerable communities. For example, homeless people are a vulnerable community among whom there is a high prevalence of HCV. With many homeless people being placed in temporarily housed communities during COVID-19, this has presented the opportunity of increasing testing among a
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©David Marchal
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