PHE reports on progress towards hepatitis C elimination and impact of COVID-19

On 14th December, Public Health England published their annual 'Hepatitis C in the UK' report. This analyses the UK's progress towards the World Health Organization's target of eliminating hepatitis C by 2030 at the latest, which the UK Government signed up to in 2016 and all devolved nations are committed to reaching.

The latest report uses 2019 data to assess progress towards elimination, but also includes a section on the impact of Covid-19 on hepatitis C services in 2020, noting that "the Covid-19 pandemic poses a serious threat to our ability to meet WHO HCV elimination goals".

Even before taking into account the disruption of services this year, data from 2019-2020 paints a mixed picture, with huge successes in treatment balanced by little progress in preventing new infections.

Good news on treatment and deaths

The report does shows significant progress has been made against key WHO targets. In 2019/20, more than 15,000 people began treatment, more than double pre-2015 levels. Thanks to these high treatment rates hepatitis C prevalence has fallen by around a third to 118,000 acriss the UK. In addition, the UK has hit the 2020 target of 50% of people ever infected knowing their status, though the report notes that more must be done if we are to reach the 90% target by 2030.

Another piece of good news is the dramatic fall in hepatitis C related deaths. Deaths from hepatitis C related liver disease and cancer peaked in 2015 at nearly 500. Since then, due to new testing and treatment initiatives, they’ve fallen by 25%. This means the UK will surpass the WHO’s target to reduce hepatitis C related deaths by 10% by 2020.

Preventing new infections

On the other hand, there has been little progress in reducing of new hepatitis C infections: HCV prevalence in recent initiates to injecting was similar in 2019 to that in 2015 (around 28%), where the WHO targets call for a 30% reduction of new infections.

The lack of a reduction in new hepatitis C infections makes clear that more efforts are needed to ensure harm reduction provision is as good as possible. You can read more about what we’re doing as a charity on this here.

The impact of COVID-19

The report finds that while the impact of Covid-19 initially led to restricted availability and accessibility of testing, treatment and needle and syringe provision, services quickly adapted and developed innovative models of delivery. This included testing and treating homeless people accommodated under the ‘Everyone In’ policy. According to a recent London Joint Working Group on Substance Use and Hepatitis C report, 7% of the over 1,000 people tested in London as part of the project had a current hepatitis C infection.

Despite these initiatives, the number of new diagnoses and treatment starts fell dramatically in the months after the COVID-19 pandemic compared to the year previously. For example, in April 2020, the rate of treatment initiations was 68% lower than in January 2020. Treatment starts had begun to recover by June and July, but were still only around half of the previous year’s rates.

Public Health England have also published another report specifically on the impact of COVID-19 on sexually transmitted infection, HIV and viral hepatitis services.

Given that most new hepatitis C infections result from the sharing of injecting equipment, the effect COVID-19 has had on needle and syringe provision could lead to more hepatitis C infections. The report notes that in Scotland, the number of registered clients attending, and the number of transactions occurring at, services which provide injecting equipment has fallen and not recovered. Data from the North West of England indicates a substantial drop in the number of needles distributed and clients accessing them fell when the first lockdown came into effect and, as of June 2020, had not recovered. A small drop was also recorded in Wales. Considering the provision of injecting equipment was feared to be inadequate before COVID-19, more work is urgently needed to ensure hepatitis C infections are prevented.

You can read the report in full here.