England poised to eliminate deadly virus if those still undiagnosed can be found

Posted on: 28th March 2018

Report from the APPG on Liver Health urges national action to eliminate hepatitis C

England currently has a once-in-a-generation opportunity to eliminate a major public health threat if a national elimination strategy can be agreed, according to the report of an inquiry conducted by a cross-party group of MPs and peers.

Commenting on the report Judi Rhys, Chief Executive of the British Liver Trust, said,

“We are delighted that NHS England are committed to tackling hepatitis C and eliminating this deadly virus. A key challenge will be the fact that hep C often has no symptoms in the early stages and it is thought that less than half of those living with the virus have not been diagnosed. It is therefore vital that anyone who is at risk asks to be tested.

Importantly, we also need to ensure that there is a clear action plan for elimination and that all of the stakeholders are involved in implementing this. This report provides a series of recommendations that are the basis of a coherent strategy – let’s work together now to put it into action.”

NHS England announced in January 2018 it would aim to eliminate hepatitis C by 2025 at the latest, five years earlier than the World Health Organization’s goal of eliminating the virus by 2030. Negotiations between NHS England and industry regarding a long-term treatment funding agreement are currently ongoing.

However, expert contributors to the inquiry overwhelmingly agreed that England is currently not on track to achieve even the less ambitious World Health Organization target of elimination by 2030. Significantly greater numbers of people must be tested, diagnosed, and treated in coming years in order to eliminate hepatitis C.

The upcoming deal between NHS England and the pharmaceutical industry must include innovative new measures to find those still living with hepatitis C and engage them into treatment. The report also calls on the Government to express its explicit support for the elimination agenda and ensure that the upcoming agreement is accompanied by ambitious national and regional targets and mechanisms to ensure funds are distributed equitably.

Drawing on contributions from experts from across the hepatitis C care pathway, the report sets out the challenges to achieving elimination of hepatitis C, including:

  • Many of the 40-50% of patients who remain undiagnosed are part of vulnerable populations with chaotic lives, or part of hard-to-reach groups who are out of touch with services and may not consider themselves to be ‘at risk’
  • Low levels of awareness and misconceptions about transmission routes among the general public and primary care workers
  • Low levels of testing in prisons, despite the implementation of an opt-out testing policy since April 2017
  • Funding pressures on local authority services having a negative impact on prevention efforts and testing initiatives
  • Overly complex care pathways creating barriers to accessing treatment

Additional recommendations on awareness-raising, prevention, testing and treatment are contained in the report, and include calls for:

  • Introduction of opt-out testing for hepatitis C in substance misuse services, with commissioning contracts stipulating clear mechanisms to hold services to account for failures to meet testing targets.
  • Treatment to be universally accessible and available in community settings like drug and alcohol services and sexual health services
  • An effective long-term funding deal between NHS England and industry supported by a national elimination plan
  • National guidance to be issued on effective implementation of opt-out testing in prisons

An estimated 160,000 people in England are living with hepatitis C, with 40-50% remaining undiagnosed[1]. Hepatitis C disproportionately affects disadvantaged and marginalised communities, with almost half of people who attend hospital for hepatitis C coming from the poorest fifth of society[2]. Hepatitis C is preventable, treatable, and curable, but can cause fatal cirrhosis and liver cancer if left untreated.

The report will be launched at an event in Westminster on the 20th March with speakers including Sir David Amess MP, Norman Lamb MP and Virendra Sharma MP.

In a cross-party foreword to the report, Sir David Amess MP, Virendra Sharma MP, Baroness Randerson and Baroness Masham said: “In many parts of the country, great progress has been made in tackling hepatitis C. Yet low awareness, sub-optimal testing levels, overly complex care pathways, a fragmented commissioning environment, and short-term treatment funding models all present significant challenges. The lack of national coordination holds England back from bold international leadership on this critical public health issue.

To press forward towards achieving NHS England’s ambition to eliminate hepatitis C by 2025 at the latest, five years before the World Health Organization target, there is no time to waste in putting new interventions into practice.”

Sir David Amess, co-chair of the APPG on Liver Health, added: “With the exceptional context of a deadly virus now being fully curable with easily deliverable, highly cost-effective medicines, finding those still undiagnosed and living with hepatitis C should be a national ambition.

Eliminating a public health issue that disproportionately affects some of the poorest and most marginalised groups in our society is an extraordinary and eminently achievable opportunity which should be seized with both hands.”

Charles Gore, Chief Executive of The Hepatitis C Trust, said: “Much as there has been great progress, as this report makes clear, we all need to up our game. No-one should be walking round with a virus that could give them liver cancer. No-one should have to wait for treatment. No-one should die from this disease when we have these miraculous drugs. We can eliminate this virus so let’s get on with it.”