News Focus
For the stories behind the news www . drinkanddrugsnews . com
AN END IN SIGHT ?
Despite its prevalence , hepatitis C has long been under-prioritised by health services . But could new drugs and a new commitment from the NHS mean we may finally see this killer condition eradicated ?
Last month Public Health England ( PHE ) published the updated version of its ‘ liver disease atlas ’, which unsurprisingly made for grim reading . Not only does liver disease account for 12 per cent of total deaths among men in their 40s , but people in the most deprived communities who die from the condition will do so a decade earlier than those in more prosperous areas ( see news , page 5 ).
While many of the deaths on the PHE map are alcohol-related , many more will be a result of hepatitis C , and PHE has renewed its call for people to get tested as a ‘ substantial proportion ’ of those living with the virus are unlikely to be aware that they are infected ( DDN , September , page 4 ).
Despite hep C ’ s prevalence and its reputation as the ‘ silent killer ’ the condition has been , says the Hepatitis C Trust , ‘ grossly under-prioritised ’ by health services ( DDN , November 2013 , page 4 ). That , however , seems to be changing , with a recent commitment from NHS chief Simon Stevens to invest in ‘ revolutionary ’ new treatments and continue to work closely with the pharmaceutical industry to bring prices down .
The comments were ‘ really welcome ’, Hepatitis C Trust deputy chief executive Rachel Halford tells DDN , as ‘ he ’ s out there in public now – there ’ s a commitment that there perhaps wasn ’ t two years ago ’. The trust however has stressed the need for the government to take ‘ bold action ’ in partnership with the industry to make availability of the new treatments universal .
‘ I think there ’ s been a great improvement ,’ says Halford . ‘ I think the biggest problem we have now is finding all the undiagnosed . If things continue as they are , the concern is that the ODNs [ Operational Delivery Networks for treatment ] run out of patients so the emphasis has to be on finding the undiagnosed and supporting people into treatment . We ’ ve got Simon Stevens ’ comments , the price of the drugs has dropped dramatically and we know that there are more coming on line , so essentially what we need is to ensure that we have the people in place to access the treatment .’
While stigma inevitably remains a
8 | drinkanddrugsnews | October 2017
Right : Premature mortality from chronic liver disease and cirrhosis in people aged under 65 in the UK and European Union ( EU ) countries before and after 2004 , and France and Sweden , 1970-2014
‘ Stigma will always be an issue , but if we can we raise awareness around the new treatments then it all becomes more common .’
RACHEL HALFORD
100,000 population
Standardised mortality rate per
35
30
25
20
15
10
5
0
France Sweden United Kingdom EU members before May 2004 ( EU - 15 ) New EU members since May 2004 ( EU - 13 ) All EU members since May 2004 ( EU - 28 )
1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Year
From : The 2nd Atlas of variation in risk factors and healthcare for liver disease in England . http :// fingertips . phe . org . uk / profile / atlas-of-variation /
significant barrier it ’ s also important to ‘ change the actual message ’, she stresses . ‘ You have people who perhaps were diagnosed some time ago and have dropped off the radar , and one of the things we hear from drug services we work with is that people still think they ’ ll be getting interferon . We need to change the message so that it ’ s about oral treatments with no – or limited , short-term – side effects . Stigma will always be an issue , but if we can we raise awareness around the new treatments then it all becomes more common . So hopefully you ’ ll just go to your GP , get your prescription and off you go , as with something like antibiotics . That ease of access in itself would de-stigmatise it .’
A new report from the London Joint Working Group on Substance Use and Hepatitis C ( see column , facing page ) sets out a number of recommendations for improving access , including that testing be offered in all drug treatment services and needle exchanges , and GP practices be commissioned to offer testing to former drug users and those not in contact with services . The report also wants to see integrated HCV treatment commissioned within drug treatment where possible , a call the trust backs .
‘ Part of the remit of the ODNs is to have outreach , and drug services are the obvious places to do it – there are some that already do ,’ says Halford . ‘ There ’ s no reason why nurses can ’ t be out there doing everything and going into drug services . We ’ ve got a pilot in Birmingham where a nurse runs a clinic inside a drug service , which we ’ re running with the support of peers to see if we can reduce DNAs [ Did Not Attends ].’ Another opportunity is prisons , she states , with estimates of the proportion of the prison population with hepatitis C ranging from 10 to 24 per cent . ‘ The prevalence , if you average it out , is probably around 15 per cent – that ’ s a big prevalence , and a captive audience .’
The trust has said before that with the right action there ’ s no reason why hep C couldn ’ t be eliminated within the next decade . Does the new NHS position make that aim more realistic ? ‘ I think it does ,’ she says . ‘ And also the work happening in Scotland and Wales – they ’ re the ones leading the way with their commitment and action towards elimination , so what we need to see from our government is some kind of framework or action plan . While it ’ s fantastic that Simon Stevens has stood up and said what ’ s he ’ s said , we still don ’ t have a strategy , a plan , a framework .
‘ The framework we worked on with NHS England was abandoned last year , and they were going to be putting together some kind of operational delivery framework but that hasn ’ t come to fruition either . So I think what we need is something substantial in writing that lays out the pathways and maps out exactly how we ’ re going to achieve this , because we will see that in Scotland and Wales . They can calculate the numbers they ’ re treating , how many will be left in 2020 , and so on . What we need to see is our government and the NHS doing that as well .’
www . drinkanddrugsnews . com