Report indicates more investment in harm reduction needed to tackle hepatitis C

Public Health England has published its annual report monitoring blood-borne virus infection and injecting habits among people who inject drugs in England, Wales and Northern Ireland. The report is based on the Unlinked Anonymous Monitoring (UAM) Survey of people who inject drugs and explores trends from 2010 to 2019.

The 2020 update reflects the recent drive to find and treat people for hepatitis C. Antibody prevalence (indicating that someone has had hepatitis C at some point) among people who inject drugs remained stable at 54%, while the proportion of these people who were also RNA-positive (indicating an active infection) had dropped to 42%, down from 50% in 2018, and 58% in 2012. Around two-thirds (39%) of people with an active hepatitis C infection reported being offered and accepting treatment in 2019.

However, the report finds that there has been no decline in hepatitis C transmission in recent years, despite ramped up case-finding initiatives and many more people being tested and treated for the virus. This may be explained by the fact that the level of direct needle and syringe sharing reported by UAM survey participants had remained constant over the past decade at around 20%. Direct sharing was much higher among women injecting drugs (25%) than among men (19%). Indirect sharing (the sharing of needles, syringes, mixing containers, or filters within the last four weeks), remained constant at 37%. The sharing of contaminated drug-taking equipment is the biggest risk factor for hepatitis C, accounting for around 90% of new infections. The research did not cover access to harm reduction initiatives, except that 90% of respondents to the UAM Survey had at some point ever accessed a needle exchange.

2019 saw an increase in the number of people who had accepted an offer of testing for hepatitis C within the previous year, from 39% in 2010 to 46% in 2019. Concerningly, among those who were found to have an active infection, only 30% were aware of their infection, down from 47% in 2018. This compares unfavourably to HIV, where 100% of survey respondents testing positive for HIV were aware of their status. The report warns that this finding should be interpreted with caution due to “variable sampling methods and geographical distribution in 2019”.

Finally, the number of people who inject drugs reporting being homeless during the last year (42% in 2019, almost double that of a decade before) and the number of people reporting overdosing in the same period (20% in 2019), had both significantly increased on previous years.

Rachel Halford, Chief Executive of The Hepatitis C Trust, said: “This latest report from Public Health England clearly demonstrates that greater investment and focus is needed to improve harm reduction initiatives for people who inject drugs. Making sure people have access to clean needles and syringes is essential to reducing the transmission of blood-borne viruses like hepatitis C and HIV.

"If we are to eliminate hepatitis C by 2030, we cannot do it by treating people alone. We need the same drive and funding commitment to harm reduction as we’ve seen to finding and treating people with hepatitis C. We need to ensure that the significant investment by NHS England and the incredible efforts of drug and alcohol treatment services, peers, nurses and many others do not go to waste.”

Read the report here.