7 years to go: Healthcare leaders call for united approach to eliminate hepatitis C by 2025
December 5, 2018
More must be done to coordinate drugs services, prisons, pharmacies, GP practices and secondary care around one strategic vision if London is to become the first global city to eliminate hepatitis C, the annual conference of the London Joint Working Group on Substance Use and Hepatitis C (LJWG) heard this week.
The conference brought together over 200 experts and staff working around hepatitis C to discuss the challenges and solutions to eliminating hepatitis C by 2025, in line with NHS England’s national ambition.
Sessions included presentations on the changing landscape and future of hepatitis C treatment, hepatitis C as a health inequalities issue and the cost-effectiveness of case-finding interventions. In the afternoon, attendees broke up into workshop groups to discuss the barriers and solutions to tackling hepatitis C in drugs services, pharmacies, and prisons, as well as how best to reach those who are not in touch with services.
Dr Suman Verma, co-chair of the London Joint Working Group and Pharmacy project lead, presented on the group’s work expanding hepatitis C testing to NSP community pharmacies. The pilot project has demonstrated that community pharmacies offer an effective setting to test and diagnose vulnerable, high-risk populations whose interactions with other healthcare services are otherwise sporadic, and that those testing positive reported a strong preference to receive antiviral treatment in the pharmacy. The pilot’s transferability is also being assessed in Birmingham and Manchester, with the goal of providing hepatitis C curative treatment directly in the community pharmacies, if regulatory barriers can be overcome.
Expert and patient groups including The Hepatitis C Trust and the All-Party Parliamentary Group on Liver Health have called for increased community outreach efforts to ensure all those living with hepatitis C who are undiagnosed or out of touch with services are tested, treated and cured.
Dr Suman Verma, Consultant Hepatologist at the Chelsea and Westminster Hospital and co-chair of the LJWG, noted, “Quite simply, we need to adopt a more patient-centred approach and make access to testing and treatment easier for all patients. We have therapy that only requires taking tablets for several weeks, and can cure hepatitis C in over 95% of patients. However, we still need to do more to get this message out there so everyone who has been or is currently at risk, are encouraged to get tested and cured.”
Dr Emily Finch, Consultant Addiction Psychiatrist at the South London and Maudsley NHS Foundation Trust and co-chair of the LJWG added: “With only 7 years to go until we reach our 2025 ambition to have effectively eliminated hepatitis C in London, we know there is a lot to do. There is a real sense of momentum and energy amongst people working in the field of hepatitis C at the moment. We want to harness this to drive forward action in drugs services, prisons, general practice, hospitals, pharmacies and communities across London”.
“It is critical we understand and explore alternative means of engaging with these patient populations,” says Dr Andy Ustianowski, Former Chair of the British Viral Hepatitis Group and Consultant in Infectious Diseases, North Manchester General Hospital. “As a therapy area, hepatitis C has clear challenges around awareness, stigma, diagnosing the undiagnosed and engaging the unengaged. To achieve the 2025 elimination target means identifying touchpoints for interaction and developing simple engagement models that incentivise and pull patients in for diagnosis, and retains them throughout the treatment pathway.”
Dr Andy Ustianowski
Janet Catt, Nurse Consultant, King’s College London, added: “The landscape is shifting in the field of hepatitis C and recent initiatives have aptly demonstrated how a joined-up approach involving community and clinic can engage with vulnerable, at-risk populations to increase diagnosis and treatment rates. Projects that innovate to improve the experience for service users and providers will ultimately enable greater access to diagnosis and care for all patients living with hepatitis C and drive us firmly toward the 2025 elimination target.”
Hepatitis C is transmitted through blood-to-blood contact and, contrary to popular myth, cannot be spread via spitting, coughing, sneezing or other physical contact. It is preventable, treatable and curable for the vast majority of people. Since 2015, hepatitis C treatment only requires tablets, given for short durations, with limited side-effects and cure rates upwards of 95%.
People who inject drugs are the group most at risk of becoming infected with hepatitis C, and anyone who is injecting drugs, or has ever injected drugs, even once or a long time ago, should get tested. Other high-risk groups include men who have sex with men, people in the South Asian community, people who inject anabolic steroids and people who received a blood transfusion prior to 1991. Travel to certain countries for cosmetic or medical treatment can also be a risk factor.
There are estimated to be more than 40,000 people living with hepatitis C in London, of which a large proportion (40%-50%) are not aware they have the condition.1 Hepatitis C is often symptomless in the early stages but can lead to liver cancer and cirrhosis if left untreated.