Expert working group recommends bold action to eliminate hepatitis C in Scotland; now we need a national elimination strategy

A new report published by Health Protection Scotland sets out national recommendations for improvements to case finding and access to care which would accelerate Scotland’s efforts to eliminate hepatitis C.

The report was produced at the request of the Scottish Government by a group of expert clinicians who reviewed existing evidence and agreed recommendations on four key topic areas. Proposed recommendations were also discussed at a national stakeholder event and directly with Alcohol and Drug Partnership leads.

The report recommends the national roll-out of a series of interventions which were found to be effective in increasing numbers of people tested and treated for hepatitis C and reducing new transmissions.

The Hepatitis C Trust welcomes the recommendations of the report, which are in line with leading examples of best practice in tackling hepatitis C and follow a similar approach to recommendations made in our 2018 report Eliminating Hepatitis C in Scotland: A Call to Action. We would like to emphasise our support for the following recommendations, which would represent significant improvements on current circumstances if fully implemented at a national level:

·       HCV testing should be opt-out at services used by groups at highest risk of HCV, and the requirement to offer testing should be written into service contracts

·       All pharmacies that dispense OST or provide injecting equipment must offer testing or have a clear pathway into testing and treatment

·       HCV treatment and care services should accept referrals from patients, peers, and third sector partners, in addition to referrals from healthcare practitioners

·       Treatment should be provided in a variety of locations close to the patient, and must be available in all appropriate Drug Use services

·       Pilots should be conducted to investigate the effectiveness of point of care testing, self-testing, and other novel approaches of testing, and upscaling of novel testing methods if proven effective

While we fully support the findings of the report, we are concerned that its publication has been significantly delayed, and that this represents a corresponding delay for publication of a national hepatitis C elimination strategy which the Scottish Government has committed to producing.

To implement the recommendations of the national working group, significant further action and leadership will be required at a national level, and questions of funding and strategic co-ordination will need to be addressed.

The Scottish Government’s commitment to producing a national hepatitis C elimination strategy was referenced in the national drug and alcohol strategy published in November 2018, and was stated publicly on numerous occasions in 2018.

The Hepatitis C Trust calls on the Scottish Government to set out a clear timeline and process for developing and releasing a national elimination strategy for hepatitis C, in order to facilitate implementation of the recommendations contained in the recent Health Protection Scotland report.

An estimated 34,500 people in Scotland are chronically infected with HCV (HPS, 2016). Approximately 15,500 (45% of the total) have not yet been diagnosed, and a further 13,200 have been diagnosed but have never received treatment.

Scotland is committed to the World Health Organization goal of eliminating hepatitis C by 2030. Though Scotland has previously been considered a world leader in moving towards elimination, NHS England announced in January 2018 that it would aim to eliminate hepatitis C by 2025 at the latest, five years earlier than the World Health Organization’s goal. England is currently conducting negotiations with industry in pursuit of a long-term funding agreement for hepatitis C treatments which would also include a case-finding element.