London comes together to treat hepatitis C during lockdown

Today the London Joint Working Group on Substance Use and Hepatitis C (LJWG) launched a report, supported by the Mayor of London, to spotlight the partnership that came together to offer hepatitis C testing and treatment interventions for the homeless population in London during the Covid-19 pandemic.

Hepatitis C, a virus that attacks the liver, disproportionately affects people who are homeless and is a serious cause of health inequalities. The mean age of death for someone who is homeless is more than 30 years lower than the average for the general population, making addressing health inequalities a priority for this population.

In London during the spring Covid-19 lockdown of 2020, healthcare teams, peer workers, hotel staff and others came together to make the most of the ‘Everyone In’ policy, which aimed to house people sleeping rough in temporary accommodation to prevent the spread of Covid-19. Taking this opportunity to engage people while they were housed for an extended period of time, partners from across London delivered a hepatitis C testing operation in hotels, hostels and on the streets.

The results of this initiative have been published today in the LJWG’s report, ‘Hepatitis C testing and treatment interventions for the homeless population in London during the Covid-19 pandemic: Outcomes and learning’. The report uses analysis from a pan-London data schedule set up by the LJWG to facilitate collaboration alongside interviews with people involved in the planning and delivery of the initiatives to draw learnings and explore how the collaborations initiated during this process can be carried forward into 2021.

The report finds that over 1,000 people were tested for blood-borne viruses (BBVs) over the course of 98 testing events held between May and August 2020, including for hepatitis C, HIV and hepatitis B. More than one in ten people (11%) of those who were tested for hepatitis C were found to have antibodies for the virus, indicating a past or active infection, and 7% of all those tested for hepatitis C were identified as having an active infection. By November 2020, 43 people had commenced hepatitis C treatment, demonstrating the importance of continued hepatitis C testing outreach for the homeless population if London is to eliminate this disease by 2025, as NHS England has aimed to do.

Dr Tom Coffey OBE, Senior Health Adviser to the Mayor of London, said: “We know that hepatitis C disproportionately affects some of the most vulnerable and under-served people in our society, including people who are homeless and people who inject drugs. With an impressive partnership approach across healthcare, charities and the GLA, London has been able to offer hepatitis C testing and treatment, alongside other important healthcare interventions, throughout the pandemic lockdown period to people who are homeless.

“If London is to eliminate hepatitis C before 2025, testing and treatment must continue despite Covid-19. The model developed for testing in the last few months presents a fantastic opportunity to continue this progress.”

Dee Cunniffe, Coordinator for the LJWG, said: “We could never have imagined when we launched our Routemap to eliminating hepatitis C with the support of the Mayor of London at the start of March this year how the world would have changed by 2021. And yet thanks to the incredible hard work and innovation of everyone working on the BBV testing initiative in London, we have continued to find and treat people for hepatitis C, contributing significantly towards national elimination efforts.”

Julian Surey, Project Delivery Manager at the Find and Treat team, University College London Hospitals NHS Foundation Trust, said: “The project has turbocharged joint working between organisations, enabling us to offer a variety of tests and support to people who are homeless. We’re known as the homeless outreach team; we’ve got hepatitis C outreach, great links to The Hepatitis C Trust peers, we’ve been doing HIV testing and now we can offer sexual health testing and support, which is brilliant.”

Stuart Smith, Director of Community Services at The Hepatitis C Trust, said: “It has been fantastic to see how, under extremely demanding circumstances, organisations have been able to come together and provide such high value health services to the homeless population at such a time of need. As well as the work from the NHS and third sector, we would like to thank the peer workers who have been instrumental in engaging this group into testing and treatment for hepatitis C. We look forward to building on this model and future partnership work as London begins its recovery from the pandemic in 2021.”

Download the report here.