New Public Health England report shows moderate reduction in active hepatitis C infection among injecting drug users

Public Health England’s (PHE) annual report exploring infections and injecting behaviours among people who inject drugs in the UK was published recently. The report is informed by the Unlinked Anonymous Monitoring (UAM) Survey of people who inject drugs in England, Wales and Northern Ireland and the Needle Exchange Surveillance Initiative (NESI) in Scotland, among other sources.
Moderate reduction in hepatitis C prevalence
The findings indicate that since 2016 there has been a moderate reduction in chronic hepatitis C prevalence (or the number of people with an active infection who require treatment) in England, Wales and Northern Ireland (from 29% to 23%) and a significant reduction in Scotland (from 39% to 19%). This reflects uptake of direct acting antiviral (DAA) treatment and the intensified drive to find and treat people with hepatitis C by health and drug services over the last few years. Currently, around one in four people who use drugs are infected with hepatitis C, compared to 0.8% infected with HIV and 0.3% infected with hepatitis B.
No change in transmission rates or sharing of needles
PHE states that transmission of hepatitis C among people who inject drugs in the UK has not decreased in recent years. This is in part due to continuing behaviours that put people at risk of blood-borne viruses, such as sharing drug-taking equipment. Levels of direct sharing of such equipment has been steady over the past decade, with around 20% of people responding to the UAM survey reporting they had shared needles and syringes in the preceding four weeks, rising to 37% when including other paraphernalia such as filters and spoons. Further, the report found that Covid-19 had impacted on people’s access to substitute drug treatment and needle and syringe exchanges.
Testing
The report found that in 2019 only 30% of UAM respondents were aware of their chronic hepatitis C infection, a lower proportion than in previous years. Just under half (46%) of people who inject drugs responding to the UAM survey reported being tested for hepatitis C in 2018 or 2019, with a further 41% saying they had at some point been tested for hepatitis C. In Scotland, 60% of respondents to NESI reported a recent test, while another 31% said they had had a test at some point.
In addition, 19% of participants in the UAM survey said they had difficulty accessing blood-borne virus (BBV) testing. This was reflected in an additional survey sent out by specialist centres participating in the UAM survey in September 2020, in which 45% of centres said they had stopped BBV testing during the pandemic and 24% were still reporting current disruption to hepatitis C testing.
Treatment
The UAM survey findings showed that among participants testing positive for hepatitis C, 39% had been offered and accepted treatment. In Scotland, this number was far higher – and a marked increase on recent years – at 70%. The Covid-19 pandemic has slowed this progress in some regards, though one third (36%) of specialist centres responding to a supplementary UAM survey reported strengthened relationships with local partner organisations, such as The Hepatitis C Trust.
Trends in drug use
While heroin remains the most commonly injected drug in the UK, cocaine injecting has increased in England and Wales and crack injecting remains high, both of which are associated with risky behaviours such as sharing injecting equipment and BBV transmission. The report also pointed towards an increase in drug use in 2020 compared to 2019, with 15% of respondents to an enhanced Covid-19 survey saying they injected drugs more frequently last year, and a further quarter saying their primary drug or drug combination had changed in 2020.
 
Rachel Halford, CEO of The Hepatitis C Trust, said: “The latest findings from Public Health England demonstrate both the achievements of the past few years and a clear indication of the challenges that lie ahead. Increasing the availability of needle and syringe services and delivering education around safer injecting practices will be critical to reducing new infections of hepatitis C. Covid-19 may have delayed progress towards elimination, but by building on the partnerships that changing delivery models have developed in the past year, we can continue to drive towards a world in which no one needs to experience the preventable harms of hepatitis C.”
You can read the report here.