Hepatitis C elimination in England

Recent data from England demonstrate considerable progress towards eliminating hepatitis C virus (HCV) as a public health threat. Modelling estimates that 55 900 people aged 16 years or older were living with chronic hepatitis C in England in 2023, a decline in prevalence of 56·7% since 2015. Around 78·3% of those diagnosed between 2015 and 2023 initiated treatment, approaching WHO’s target of 80%.

A national elimination programme implemented by NHS England, in partnership with industry and lived-experience partners, has been transformative. Founded on broad access to direct-acting antiviral drugs, the programme has adopted case-finding and treatment initiatives to increase diagnosis and treatment rates, including test-and-treat approaches in prisons and probation services, and emergency department and pharmacy testing. As a result, the overall number of people who have cleared the virus has nearly doubled since 2015, and HCV-related mortality is now well below the WHO target of 2 per 100 000.

However, substantial gaps remain. Chronic HCV prevalence among people who inject drugs fell to 7·2% in 2023, yet only 27·8% were aware of their status—far short of WHO’s overall diagnosis target of 90%. Moreover, although 58·1% of people in England who inject drugs and are dependent on opioids receive opioid agonist therapy, exceeding WHO goals, a third of people who injected drugs in the past year report inadequate access to needle and syringe programmes.

The clear progress demonstrates that HCV elimination is achievable with sustained commitment. However, the final phase will be the most challenging, requiring targeted interventions for populations that are poorly reached by existing services, and further investment in beleaguered harm-reduction services.