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
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
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
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