Public health, particularly relating to infectious diseases, is on everyone’s radar at the moment.
The hepatitis C virus is a very different virus to the novel coronavirus but one principle that people have become aware of over the last few months might be familiar: namely, that testing and care needs to be available to everyone in society if we’re to eliminate it as a public health concern.
The 28th July is World Hepatitis Day, a chance to reflect on our efforts to eliminate this virus and the lessons we have learnt along the way.
Hepatitis C is spread through blood-to-blood contact and in the UK over 90% of new hepatitis C infections come from the sharing of contaminated injecting drug equipment. Most people who are exposed to the virus develop a chronic infection which is often asymptomatic or presents with vague symptoms, making testing essential to detection. Despite its often-asymptotic nature, over time, the virus can do serious and potentially fatal damage to the liver.
Over the last decade we have seen the introduction of extremely effective treatments for hepatitis C which clear the virus in 95% of cases and are taken as tablets or pills. NHS England is now engaged in a drive to eliminate hepatitis C by 2030. This involves both the health service and pharmaceutical companies which produce treatments contributing to case-finding measures to find the tens of thousands of people in England who have the virus and are undiagnosed.
Despite these new treatments, and a decrease in the overall prevalence of hepatitis C in the UK, certain sections of society have seen less benefit from these medical advances.
For example, among people who inject drugs who report homelessness; since 2011 the proportion who had a chronic hepatitis C infection has risen to over a third.
This inequality should particularly concern local authorities given they have a role commissioning services both for people who are homeless and people who inject drugs, including hepatitis C testing in drug and alcohol services.
The good news is that during this pandemic we have seen signs of just how well health services, local authorities, homelessness services and drug and alcohol services can work together to support the most disadvantaged in our society with their health.
From May, with the aid of PPE and social distancing, services have been working to test people accommodated in hotels and hostels who would otherwise be homeless for blood borne viruses, including hepatitis C.
We know that in the areas where this testing has been carried out, hundreds of people have been tested and those positive for the virus have been started on treatment. Given the difficulty health services often have in reaching and engaging this cohort, this is a huge success.
The success of these events has been a result of excellent multi-agency partnership working. For example: The Hepatitis C Trust peer support workers have used their lived experience of hepatitis C to provide support and combat the stigma and myths which persist around this virus; whilst nurses and doctors have provided testing with rapid turnaround on results. This all happened alongside other support service’s work to address other issues like mental health and drug and alcohol needs.
We can draw multiple lessons from these successes. The first is that we can test and treat those who are thought of as the hardest to engage, potentially arresting the spread of hepatitis C among the most vulnerable in our society. Secondly, the support that one services provides can help with other needs too and giving holistic support via different agencies is possible. People were able to get tested and treated for hepatitis C at the same time as their drug and alcohol or mental health needs were being addressed. We do not have to choose which issues we help people address.
Testing and starting people on hepatitis C treatment is not the end of journey. People might need support to complete treatment and harm reduction measures which local authorities commission, such as opioid substitution therapy and needle and syringe programmes, which have been proven to prevent new hepatitis C infections and have a role to play in preventing reinfection.
We need to make sure efforts like this do not go to waste and that the health gains patients have made are not lost. Clearly, ensuring stable, safe accommodation is vital. Local authorities and commissioners also need to build on the excellent work of recent months by ensuring they commission effective hepatitis C prevention and testing services to help the UK meet its commitment to eliminate the virus by 2030 at the latest.
Rachel Halford is chief executive of The Hepatitis C Trust