The new report from Public Health England (PHE) highlights the effect of plans to lower HCV-linked mortality and number of new infections in England, and the action items on making further progress. The 2 key impact areas in the path to HCV elimination are reduction in the number of individuals seriously ill or dying from HCV infection and reduction in the number of new and re-infections.
The report reveals that the decline in HCV-linked mortality remains sustained for a second year in a row, suggestive of a 3% drop in mortality from HCV-related end-stage liver disease and hepatocellular carcinoma between 2014 and 2016. This may be attributable to an increased treatment uptake of direct-acting antiviral (DAA) drugs (a 19% increase in 2015/16 compared with before, and 56% rise in 2016/17 than in 2015/16), especially in those with more advanced disease. There has also been a decline in liver transplant registrations (43% drop) and liver transplants (25% drop) from pre-2014 to 2016. The findings, therefore, are in agreement with the WHO's goal of a 10% reduction in HCV-linked mortality by 2020.
There has been a more than 5-fold rise in the number of laboratory-confirmed reports of HCV in England over the past 2 decades (1996-2016). England may have already met the WHO European Region target of 50% individuals with chronic HCV having been diagnosed and aware of infection status by 2020. However, to meet the goal of 90% diagnosed by 2030, much more needs to be done. Additionally, the report indicates an increased uptake of HCV testing among new inmates in English prisons from 5.3% in 2010-2011 to 10.5% (provisional) in 2016-2017.
The report emphasises that several challenges remain in attaining WHO's goal of 30% decline in new chronic HCV cases by 2020 and 80% decline by 2030. The proportion of people who inject drugs (PWID) reporting adequate needle and syringe provision remains suboptimal, and there has been no decline in needle sharing rates in the last 5 years. A radical change in approach is required for HCV among PWID.
