Scientists reveal blueprint for getting hepatitis C treatment to people who inject drugs
Published on 11 August 2021
Scientists have revealed a new method of delivering hepatitis C testing and treatment to people who inject drugs which will help bring the world a step closer to eliminating the virus.
University of Dundee experts, working with colleagues at Glasgow Caledonian University (GCU) and the University of Bristol, in collaboration with NHS Tayside and the Scottish Drugs Forum (SDF), have just published a ‘game-changing’ blueprint on how best to get hepatitis C treatment to those who need it most after a successful three-year trial in NHS Tayside.
The breakthrough in getting treatment to those who inject drugs – studied as part of the National Institute for Health Research (NIHR)-funded EPIToPe (Evaluating the population impact of hepatitis C direct-acting antiviral treatment as prevention for PWID (people who inject drugs) project – will help guide efforts in Scotland to eliminate hepatitis C by 2024.
Key recommendations include introducing a nurse-led community service for hepatitis C testing and treatment, recruiting peer workers who know the local drug culture and creating close ties between existing community services for people who inject drugs.
Researchers say the ideal model would be to house all these services in one building but where this is not possible the links between these services need to be strengthened including data sharing systems, role sharing and post-treatment care and support. A key part of that support is ongoing testing and treatment to prevent re-infection. It is hoped the guide will be rolled out across the UK and around the world.
The Scottish Government welcomed the findings and Public Health Minister Maree Todd said: “These recommendations will be a valuable resource as we continue to work towards our target of eliminating Hepatitis C in Scotland by 2024.”
The hepatitis C virus (HCV) is a blood-borne disease that can seriously damage the liver and is spread mainly through blood-to-blood contact with an infected person. Despite effective Opioid Substitution Treatment and Needle Syringe Programmes, chronic hepatitis C prevalence remains at around 40% among people who inject drugs in the UK.
The World Health Organization (WHO) has set an elimination target to reduce hepatitis C transmission by 80% and deaths by 65% by 2030, and researchers believe this new method of getting treatment to those who inject drugs in communities will have a major impact on cutting incidence and death rates.
Lead GCU researchers behind the blueprint, Professor Lawrie Elliott, Dr Gabriele Vojt and Professor Paul Flowers, now at Strathclyde University, described the research as a “game changer in the design of hepatitis C treatment programmes for those who inject drugs in Scotland and beyond”.
Professor Elliott added: “We know from previous research led by GCU that the treatment works but we have struggled to get this out to those who need it. These recommendations are a major breakthrough in getting treatment out to communities and will have a huge impact on virus elimination.”
EPIToPe study co-lead and GCU Professor of Epidemiology and Population Health Sharon Hutchinson, said: “The lessons learnt from the great strides made in NHS Tayside in tackling hepatitis C are captured in the set of recommendations. They have shown that it is feasible to deliver specialist nurse-led treatment across multiple community-based services engaged with people who inject drugs.
“The set of EPIToPe recommendations will help to guide other regions and countries in efforts to rapidly scale up hepatitis C treatment in this population, as is necessary to achieve the global WHO elimination targets.”
The study was co-led by Matt Hickman, Professor in Public Health and Epidemiology and co-Director of the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, and involved experts from the University of Dundee, Public Health Scotland, and NHS Bristol, North Somerset and South Gloucestershire, with the backing of drugs charities With You and The Hepatitis C Trust.
NHS Tayside Consultant Hepatologist and Gastroenterologist and University of Dundee Professor John Dillon said: “The goal of HCV elimination, removing the scourge of death and disease caused by HCV from our communities is within reach, but it needs coordinated action by all the players to achieve it. The recommendations are a useful tool to that end.”
Professor Hickman said scaling up hepatitis C testing and treatment in the community alongside harm reduction services was “critical” to prevention in the UK and achieving elimination targets.
“This is a very useful blueprint with practical suggestions for services and commissioners on how scale-up can be done – based on the successful transformation of services in NHS Tayside,” he added.
SDF CEO David Liddell welcomed the blueprint: “This type of assertive, responsive and inclusive approach to hepatitis C testing and treatment will go a long way to helping Scotland meet its 2024 elimination target.
“The recommendations have given us an evidence base for actions around which a consensus can readily be built as they will be consistent with the experiences of stakeholders delivering services.”
Dr Paul Hughes, Executive Medical Director at With You, said: “With You welcomes the publication of the EPITOPe study. The study findings will undoubtedly contribute to our organisational aim of helping NHS England's to eliminate Hepatitis C by 2025.”
View the full recommendations in the study here - https://www.gcu.ac.uk/hls/research/researchgroups/sexualhealthandbloodborneviruses/keyprojectsandexpertise/epitope/
Full quote from SDF CEO David Liddell: “SDF welcomes the recommendations from the EPIToPE study, research which has given us an evidence base for actions around which a consensus can readily be built as they will be consistent with the experiences of stakeholders delivering services.
“By taking services into communities, co-locating them, utilising peer workers and offering services which are nurse-led we have a far greater chance of identifying, testing, treating, and re-testing people with hepatitis C. By utilising their lived experience, peer workers can share their own experiences of testing and treatment which can be reassuring to someone at the start of the process. This ultimately helps engage people in testing and treatment and helps to reach people who may not be known to services.
“Nurse led services can allow for same day testing and treatment which is crucial for this at risk population. Co-located and better joined-up services have clear benefits in making the treatment process operate more smoothly for people who use services.
“The findings from EPIToPE align to other national work, such as the Medication Assisted Treatment standards which outlines the need for a fast response to people requiring treatment for their drug problem and a proactive approach to seeking out people who are unknown to services. They also support pioneering work such as the WAND initiative which is currently being implemented in Glasgow – which seeks to deliver a more proactive approach to people who inject drugs including an assessment of injecting risk and BBV testing.
“This type of assertive, responsive and inclusive approach to hepatitis C testing and treatment will go a long way to helping Scotland meet its 2024 elimination target.”
About the NIHR
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
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- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
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