UK faces challenge to eliminate hepatitis C
Recent research shows that several European countries, including the UK, are struggling to meet World Health Organization (WHO) 2030 hepatitis C elimination goals.
In 2016, 194 countries adopted the WHO hepatitis targets which included a 90% reduction of new hepatitis B and C infections and a 65% reduction in hepatitis B and C related mortality by 2030. However in 2017, only four countries in the WHO EURO region (53 nations) were considered on track to eliminate hepatitis C by 2030: the Netherlands, Germany, Iceland and Georgia.
However, recent analysis shows that France, Spain and Switzerland have joined the countries on track, whereas Germany has fallen off track because it is no longer treating the required proportion of infected patients annually. To be on track, a country must treat 7% or more of its infected population each year, and also have no restrictions on treatment based on disease severity. In 2017, many countries in Europe and worldwide had regulations restricting treatment to those people whose hepatitis C has left them with advanced fibrosis of the liver and thus most at risk of progression to cirrhosis or liver cancer.
The UK has made efforts to hit targets. In 2017, 6% of infected patients (some 10,000 out of an estimated 163,500 infections) were treated. However, up to and including 2017, the UK has had a treatment quota in place that has prevented it reaching the required treatment threshold of 7% on infected patients per year. NHS England recently announced plans to bring forward its elimination target by five years to 2025; however huge progress must be made in treatment and diagnosis to even reach the original 2030 targets.
Inadequate screening and diagnosis strategies mean than there are not enough patients being diagnosed and linked to treatment to meet the targets. For example, in the UK, it is estimated only 40-50% of those with hepatitis C are aware of their infection. Many of those that are aware are already linked to treatment or cured, meaning countries face the threat of 'running out' of patients to treat.
- Robbins S, Blach S, Brandon S et al. Quantifying the impact of achieving the World Health Organization global health sector strategy goals for hepatitis C in the EURO region. Abstract presented at the International Liver Congress 2018, abstract #3413. http://tonykirby.com/hepatitis/POLARISLIVERCONGRESSEUROABSTRACT.pdf
- All Party Parliamentary Group report, March 2018: Eliminating Hepatitis C in England http://www.appghep.org.uk/download/reports/Eliminating%20Hep%20C%20APPG.pdf