Vast improvements in screening, prevention and treatment required to meet global hepatitis C elimination targets

New research published today in The Lancet models the impact of public health interventions on the global hepatitis epidemic to investigate whether elimination targets set by the World Health Organization (WHO) can be met.

If improvements are made, the target to reduce the number of new hepatitis C infections by 80% could be met in 2030 and the target to reduce mortality by 65% could be met in 2032, according to the study.

Using data on demography, people who inject drugs, current treatment and prevention programmes, prevalence and mortality rates, the authors of the study created a model of the global hepatitis C epidemic in 190 countries. Using this model, they estimated the effects of four interventions – implementation of comprehensive blood safety and infection control measures; expansion of harm reduction services for people who inject drugs; provision of treatment for all people as soon as they are diagnosed with hepatitis C infection; and expansion of hepatitis C testing.

The study found that if current trends continue, the estimated number of people living with hepatitis C will gradually decrease from 71 million to 58 million by 2050 but could still rise by the end of the century. Outcomes could be even worse if access to new treatments is not improved, with considerably higher mortality and new infections.

Effective interventions could significantly improve outcomes. The implementation of comprehensive blood safety and infection control measures is estimated to reduce the number of new infections in 2030 by 58%. Extending harm reduction services to 40% of people who inject drugs could reduce the number of new infections by a further 7%.

Expanding access to new treatments would also cut future mortality rates substantially. If these interventions were combined with additional screening so that 90% of people with hepatitis C are diagnosed and offered treatment, 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths could be averted by 2030.

While the authors of the study acknowledge that eliminating hepatitis C will involve considerable practical challenges and costs, many countries are already making substantial progress. For example, in Egypt, 700,000 people were treated in 2016 as a result of innovative screening and testing strategies. In Australia, a volume-based pricing model incentivises the prescription of expensive treatment courses.

NHS England and industry are currently in negotiations surrounding a long-term funding arrangement for hepatitis C treatments. If agreed, the deal will be the largest single medicines procurement undertaken by the NHS, and is expected to further expand access to treatment and encourage additional case-finding.

Responding to the findings of the study, Rachel Halford, CEO of The Hepatitis C Trust said: “While there has been great progress towards making hepatitis C elimination a reality, this report reminds us that testing and treatment still need to be increased significantly. The new funding deal negotiated between NHS England and pharmaceutical companies could enable many more people living with hepatitis C to be identified and treated. There is no time to waste - we must ensure this deal delivers for patients as soon as possible, or risk the UK falling behind in the global fight to eliminate this deadly virus. With just over 10 years to go until we reach WHO’s target elimination date, finding those still undiagnosed and living with hepatitis C should be a national ambition.”

You can read a full report of the study’s findings here.