Injection drug use remains the most important risk factor for HCV infection in the UK.^2,3  

Data from UK surveys of people who inject drugs suggests that in 2021, over half tested positive for HCV antibody (56% in England, Wales and Northern Ireland; 55% in Scotland in 2019 to 2020), with 14% exhibiting evidence of current infection in England, Wales and Northern Ireland (19% in Scotland).² 

In order for the adoption of DAA regimens, the WHO recommend community-based HCV management through the following models of service delivery:⁶  

• Comprehensive national planning for the elimination of HCV infection based on local epidemiological context; existing health care infrastructure; current coverage of testing, treatment and prevention; and available financial and human resources.

   

• Simple and standardised algorithms across the continuum of care from testing through linkage to care and treatment.

   

• Strategies to strengthen linkage from testing to care, treatment and prevention.

   

• Integration of hepatitis testing, care and treatment with other services to increase the efficiency and reach of hepatitis services.

   

• Decentralised testing and treatment services at primary health facilities or harm reduction sites to promote access to care. 

   

• Task sharing, supported by training and mentoring of health care workers and peer workers.

   

• Differentiated care strategy to assess needs at different levels of care, with specialist referral as appropriate for those with complex problems.

   

• Community engagement and peer support to promote access to services and linkage through the continuum of care, which includes addressing stigma and discrimination. 

   

• Strategies for more efficient procurement and supply management of quality-assured, affordable medicines and diagnostics.

   

• Data systems to monitor the quality of individual care and coverage at key steps along the continuum, or cascade, of care at the population level.

   

Increasing access to HCV treatment in the UK  

In the UK, the ability to continue treatment delivery is limited by the capacity to find and treat the undiagnosed, and to deliver treatment to those who are diagnosed but untreated due to poor accessibility in places such as prisons, homelessness centres and addiction services.  

Point of care testing is being rolled out in the prison settings throughout England and has been piloted in Wales, which can allow immediate initiation of treatment for detained patients.⁷  

The National Institute for Health and Care Excellence (NICE) outlines primary care management of a person with HCV should include:⁸  

• Ensuring the person is attending specialist appointments

   

• Offering sources of information and support

   

• Advising on measures to reduce the risk of disease progression such as reducing alcohol consumption and smoking cessation.

   

The UK’s NICE guidance is based largely on the World Health Organisation (WHO) Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C and the WHO Factsheet on Hepatitis C, amongst other guidelines, such as the British Association for Sexual Health and HIV (BASHH) guidelines, and the UK Health Security Agency (UKHSA) report.⁸  

The availability of well-tolerated DAAs has prompted changes to the WHO guidelines on when and how to treat HCV patients. The guidelines now recommend:⁶  

• The use of pangenotypic DAA regimens for all adults, adolescents and children ages 3 years and above with chronic HCV infection, regardless of stage of disease.^*,†

   

   

*Assessment/consideration of liver fibrosis, comorbidities, pregnancy, and DDIs should occur prior to treatment initiation.

†The Guidelines Development Group defined pangenotypic regimens as those leading to a sustained virological response (SVR) rate >85% across all six major HCV genotypes.