B LOOD - BORNE IN F ECT ION
group often challenging to engage. There are several other examples of innovative working, demonstrating how we can implement innovative ways in reducing HCV and support the NHS in eliminating the virus by 2025. One of them is the Community Pharmacy Hepatitis C Antibody Testing Service. Originally slated to be introduced in April 2020, the programme was delayed for five months due to the pandemic and introduced successfully in September 2020.
It is specifically targeted at people who inject drugs and are not yet supported by alcohol or drug treatment services. Community pharmacies will offer them the possibility of being tested for HCV and depending on the result, the pharmacy will refer them to the appropriate ODN in order for the individual to receive further testing and treatment. This testing service aims at improving the identification of people with HCV, reducing HCV transmission, decreasing the health impacts on the individuals and finally reducing the overall treatment costs for the health system.10
While the pandemic delayed this pharmacy testing programme, it did not derail it entirely. This is a fitting encapsulation of the general approach to HCV services during COVID-19 and beyond. As COVID-19 is likely to remain at the top of the agenda for some time to come, it is crucial that it does not derail progress towards elimination and hinder the 2025 target.
The way forward
A lot of hard work and innovative thinking has gone on over the course of the pandemic, and not just for COVID-19 specifically. This should be the inspiration we take from it: that there is an urgent need to increase collaborative effort with all services involved in the patient pathway: from NHS England, the industry partners through primary and secondary care, A&E, pharmacies, prisons, charities and other healthcare providers to raise awareness of hepatitis C, identify the roughly 50%3
who
are unaware they are affected by the virus or have not yet received or completed their treatment. We also need to increase testing in order to identify those affected and get them into treatment.
Although we have been successful in reaching beyond the 2020 WHO targets, we need to pull together with renewed vigour in order to eliminate HCV virus in England by 2025. Key to this is finding and treating the unidentified population living with HCV, but as we have seen, there must be a particular focus on reducing the incidence of new infections, and reinfections in order to meet the WHO’s aim of an 80% reduction by 2030.
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. The momentum around HCV gained before COVID-19 should not, and need not, be lost. This is an opportunity: to save lives and make England a public health world leader in defeating the hepatitis C virus. CSJ
References 1 NHS England, NHS England strikes world leading deal to help eliminate hepatitis C, 30 April 2019. Accessed at:
https://www.england.nhs.uk/2019/04/ nhs-england-strikes-world-leading-deal-to-help- eliminate-hepatitis-c/
2 PHE, Hepatitis C in England 2020 Working to eliminate hepatitis C as a major public health threat, May 2020. Accessed at: https://assets.
publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/898221/ HCV_in_England_2020_report.pdf
3 PHE, Hepatitis C in the UK 2019 Working to eliminate hepatitis C as a major public health threat, September 2019. Accessed at: https://assets.
publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/831155/ Hepatitis_C_in_the_UK_2019_report.pdf
4 WHO, Key Facts, Hep C. Accessed at: https://www.
who.int/news-room/fact-sheets/detail/hepatitis-c
5 NHS England, NHS England sets out plans to be first in the world to eliminate Hepatitis C, 9 January 2018. Accessed at: https://www.england.nhs. uk/2018/01/hepatitis-c-2/
6 Accessed at:
https://www.nhs.uk/conditions/ hepatitis-c/causes/
7 PHE, Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among PWID: 2020 report. Accessed at:
https://assets.publishing.service.
gov.uk/government/uploads/system/uploads/ attachment_data/file/925702/hpr1820_UAM-
38 l
WWW.CLINICALSERVICESJOURNAL.COM About the author
Professor Steve Ryder is a consultant hepatologist at Nottingham University Hospitals NHS Trust and honorary professor at University of Nottingham, School of Medicine. He is also chair of the Hepatitis C Coalition.
FEBRUARY 2021
PWID_Final.pdf
8 Hepatitis C Trust, Report indicates more investment in harm reduction needed to tackle hepatitis C, 10 August 2020. Accessed at: http://www.
hepctrust.org.uk/blog/oct-2020/report-indicates- more-investment-harm-reduction-needed-tackle- hepatitis-c
9 Remembering the other virus for World Hepatitis Day – HCV elimination continue, Clinical Services Journal, 24 Jul 2020. Accessed at: https://
www.clinicalservicesjournal.com/story/33311/ remembering-the-other-virus-for-world-hepatitis-dayA
10 NHS England, Service specification, Community pharmacy Hepatitis C Antibody Testing Service - Advanced Service, August 2020. Accessed at:
https://www.england.nhs.uk/wp-content/ uploads/2020/08/par0097-hep-c-service- specification.pdf
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