Hepatitis C
Countdown to
NHS England’s target date to eliminate hepatitis C is now
just six years away. DDN hears what progress has been made,
and what’s left to achieve, at the LJWG on Substance Use and
Hepatitis C annual conference. Speaker pictures by Jon Derricott
‘T
he strategy from NHS England has always been to eradicate
hepatitis C,’ NHS clinical lead for hepatitis C, Dr Graham
Foster, told December’s Seven years to elimination: the road to
2025 event. ‘We’ve never pulled punches – we just want to
get rid of the damn thing for once and for all.’
Reductions in drug prices meant this was now achievable,
he said, and the strategy had been to split the country into networks and allocate
treatment numbers accordingly. ‘From the get-go we insisted on outreach
treatment, and we insisted on using the cheapest drugs. The strategy is to get out
there and find and treat, and we’ve been pretty successful. We’re still not testing
enough, but the figures are moving up. We are working, we are curing people, the
strategy is being successful.’
Testing rates in good drug services stood at around 95 per cent, while in some it
was as low as 5 per cent. ‘So the challenge is to move that bottom segment into the
top segment’. Treatment in prisons remained poor, meanwhile, and too many
needle exchanges still weren’t offering testing. However, death rates were falling, as
were waiting lists for liver transplants.
But the main challenge was that ‘too many people with a history of drug use
still aren’t getting tested’, he said. ‘We need to look at the good services and follow
their lead.’
‘For me it’s about supporting services to be doing this treatment themselves,’
said nurse consultant at King’s College, Janet Catt, adding that peers were
12 | drinkanddrugsnews | February 2019
fundamental to reaching marginalised populations. ‘A lot of people know they’re
positive, but hep C treatment can also help them engage more with drug treatment
and build goals for themselves,’ added peer support worker Chris Laker. ‘Word of
mouth builds that treatment is accessible and successful. Clients really want this.’
People who inject drugs accounted for 95 per cent of all new diagnoses,
consultant hepatologist at Chelsea and Westminster, Dr Suman Verma, told the
conference. They were a group that tended to ‘dip in and out’ of treatment, she said,
and were often of no fixed abode, with no GP and no NHS number. ‘But they do
engage with needle exchanges.’
This is where a recent pilot project offering testing in pharmacies with needle
exchange facilities had proved so successful (DDN, June 2018, page 5). The aim had
been to develop sustainable, effective point-of-care testing and pathways into
treatment, she said, adding that it was important that participating pharmacies
had adequate facilities for confidential discussion and were able to refer patients
with positive tests to the appropriate pathway.
‘But what do you do if you have no fixed abode?’ The answer was the
pharmacies themselves acting as mailing addresses for clients so they wouldn’t
miss appointment notifications, she said. In the pilot more than 50 per cent of
service users were found to be antibody-positive, and 57 per cent of those tested
were unaware that treatment was now interferon-free. ‘Opportunistic HCV testing
in NSP community pharmacies can be really effective,’ she stated.
‘We all know that hepatitis C is a huge health inequality issue that affects
‘It’s a travesty that it
wasn’t part of the
mayor’s recent report
into health inequalities.’
Susan Hall ‘People who inject drugs
account for 95 per cent
of all new diagnoses.’
Dr Suman Verma
‘Anyone who’s got a
good idea, I’m happy to
shamelessly nick it.’
Dr Andy Ustianowski ‘Word of mouth builds
that treatment is
accessible and
successful.’
Chris Laker
www.drinkanddrugsnews.com