https://publichealthmatters.blog.gov.uk/2017/07/28/the-importance-of-hepatitis-c-treatment-for-people-who-inject-drugs/

The importance of hepatitis C treatment for people who inject drugs

Each year on 28 July the World Hepatitis Alliance brings together patient organisations, governments, medical professionals and industry for World Hepatitis Day (WHD).

WHD is officially endorsed by the World Health Organization  and aims to raise awareness of the global burden of viral hepatitis, which kills as many people as HIV/AIDS – over 1.3 million people a year.

This makes hepatitis one of the leading causes of death globally; hepatitis B and hepatitis C virus (HCV) cause 80% of liver cancer cases in the world.

Our latest Hepatitis C in England report shows that around 160,000 people are chronically infected with HCV. The majority of these people come from poor and disadvantaged backgrounds and most often they inject drugs. Injecting drug use continues to be the biggest risk factor for HCV infection.

Among those who inject drugs, or have previously injected, approximately 50% have HCV, a figure that has remained mostly unchanged over the past 10 years.

But, what’s most concerning is that half of these drug users with HCV aren’t aware of their infection.

To reduce the numbers of people dying from liver disease and prevent people from unknowingly passing on their infection, it’s vital we increase understanding of the disease and its risks, as well as access to testing and treatment.

Over the past two decades we have already seen a steady increase in the number of people diagnosed with HCV infections, reaching a peak of 11,605 cases in 2015.

And levels of testing have also increased, by nearly a fifth (18.6%) overall, and by over a quarter in GP surgeries (between 2011 and 2015), which is positive news in the bid to eliminate HCV.

What’s particularly encouraging is that four-fifths of those in drug treatment who have ever injected drugs have had a HCV test.

Testing is well-established in prisons and for those entering drug treatment, but it’s vital that testing is offered regularly, even if results have been negative in the past – especially if people are still engaging in high risk activities.

If we are to meet the WHO target and eliminate HCV as a major public health threat in England by 2030, it is essential that local authorities, drug services and the NHS work together to improve testing and treatment of people who inject drugs.

Access to treatment is essential, both for individuals’ health and to remove HCV from the ‘pool’ of infection that maintains high incidence and reinfection rates.

Testing also needs to be more readily available and encouraged in other settings frequently used by people who inject drugs (or used to), such as doctors’ surgeries, community pharmacies and sexual health centres.

Treatment for HCV needs to be available where patients are: in the community and in drug services.

Drug services should do all they can do support people to access and adhere to treatment by:

  • providing incentives, such as vouchers, to encourage people to get tested and complete treatment if needed
  • prescribing, dispensing and supervising consumption of hepatitis medicines alongside opioid substitution treatments, like methadone
  • using peer support to explain and champion hepatitis treatment, and to help people engage with and complete it

In the past, HCV treatment was long and complex, and was often denied to people who had used drugs.

New treatments are shorter and easier for patients to complete and there should be no bar to treating drug users who meet treatment criteria.

The opportunity is here to have a major impact if we all play our part.

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