Hepatitis C declining among drug users in UK

The prevalence of hepatitis C in people who inject drugs has fallen modestly in England, Wales and Northern Ireland and sharply in Scotland since 2016, Public Health England reports.

Around one in four people who inject drugs in England, Wales and Northern Ireland has hepatitis C, and one in five in Scotland. The findings come from the annual Public Health England report on infections and injecting behaviour, published last month.

Public Health England says that the findings indicate a modest effect of the scale-up of direct-acting antiviral treatment but testing rates in people who inject drugs need to be improved.

However, transmission of hepatitis C and sharing of injecting equipment have not declined since 2016.

Drug use in the United Kingdom is amongst the highest in Europe and hepatitis C is highly concentrated among people with a history of injecting drugs in the United Kingdom.

Efforts to eliminate hepatitis C in the United Kingdom depend on improving the uptake of testing and treatment among people who inject drugs and former drug users, and reduction of transmission among current drug users.

Public Health England carries out annual unlinked anonymised testing among people who use drugs services, along with a behavioural survey to track drug-using and injecting behaviours. A similar survey is carried out in Scotland.

The surveys found that chronic hepatitis C infection prevalence had fallen from 29% in 2016 to 23% in 2019 in England, Wales and Northern Ireland. In Scotland, prevalence fell from 39% in 2015-2016 and 31% in 2017-2018 to 19% in 2019-2020.

The surveys found that transmission of hepatitis C has remained stable, with no change in the level of recent infections detected compared to 2016. Surveys also found little change in the sharing of injecting equipment. Twenty per cent in England and Wales said that they had shared needles or syringes and 37% said they had shared needles, syringes or other injecting paraphernalia such as filters or spoons.

Surveys also found changes in drug injecting; injection of cocaine has increased over the past decade whereas injection of stimulants such as mephedrone and methamphetamine has declined. Injecting heroin remains the most common form of drug use among people in contact with drug services; around 90% of people injecting drugs in the past six months had used heroin.

Behavioural surveys found higher rates of testing for hepatitis C in Scotland compared to the rest of the United Kingdom. Whereas 60% of people who inject drugs reported testing for hepatitis C in the previous year, 46% of people surveyed in the rest of the United Kingdom reported a test in the previous year.

However, the proportions of people ever tested for hepatitis C were similar across the United Kingdom – 91% in Scotland and 87% in England, Wales and Northern Ireland – and those reporting ever testing for hepatitis C increased more sharply in Scotland than the rest of the United Kingdom, suggesting that Scotland has been catching up with testing coverage in other regions.

In England, Wales and Northern Ireland, 39% of people who were aware of a hepatitis C diagnosis reported that they had seen a hepatitis specialist and accepted treatment. In Scotland, 70% of people aware of their infection had accepted treatment in the latest survey period, up from 28% in 2015-2016 and 50% in 2017-2018.

Preliminary findings from a national behavioural survey of people who inject drugs in 2020 shows that one in four people reported difficulties in obtaining injecting equipment due to COVID-19. One in five reported difficulties in getting tested for viral hepatitis or HIV.

Fifteen per cent said they were injecting drugs more often and one in four said they were using different drugs, most often cocaine. Public Health England says it is unclear if these changes are due to COVID-19 or evidence of a longer-term trend towards poly-drug use among people who inject drugs.