London sets out route map for hepatitis C elimination

Keith Alcorn
13 March 2020

Healthcare professionals, local government and community organisations have launched a London route map for hepatitis C elimination, setting out five 'opportunity' areas for an intensified focus on reaching undiagnosed people and vulnerable populations in the capital.

A third of new hepatitis C diagnoses in England occur in London. Over 2600 people were diagnosed in London in 2018.

The estimated number of people living with hepatitis C in London has been reduced recently, from 40,000 to 14,200, due to efforts to test and treat people in the capital. Reaching the remaining people with hepatitis C in London will be challenging as most are undiagnosed.

Reducing stigma and raising awareness

Raising awareness of hepatitis C and the availability of new treatments will be essential and stakeholders will be looking at how to reach people who are undiagnosed or disengaged from care.

Speakers at the London Joint Working Group on Substance Use and Hepatitis C conference in January were unsure if a London-wide advertising campaign to encourage testing for hepatitis C would be the best use of resources.

“We need to do an over-50s study in GP practices in London and then do a targeted advertising campaign once we know more about the profile of people testing positive,” Professor Graham Foster of Queen Mary University London argued.

Engaging people who are under-served by traditional health system

Homeless people have a higher likelihood of hepatitis C infection but most local authorities in London are not funding any work to address hepatitis C in the homeless. The London steering group will investigate how to co-ordinate existing 'find and treat' services as well as working with services for the homeless to introduce a health check that can include testing for hepatitis C. Linking hepatitis C activities into the Mayor of London’s 'Life Off the Streets' programme will also be part of the group’s work.

Working with GPs to find the under-diagnosed

London’s four Operational Delivery Networks for hepatitis C treatment will work with Clinical Commissioning Groups and general practitioners to make sure that all GPs are aware of NICE guidance on hepatitis B and C testing in primary care and equipped to offer testing.

Reducing pathway attrition

“Pathway attrition”, or the loss of people diagnosed with hepatitis C after diagnosis due to obstacles that prevent engagement with care, means that many people who receive a positive antibody test for hepatitis C never progress to a confirmed diagnosis of hepatitis C or a discussion of hepatitis C treatment, let alone start treatment. Automatic testing for chronic infection after a sample tests antibody positive needs to be implanted across London. Testing in drug and alcohol services is another priority area for the steering group.

Aligning hepatitis C and HIV public health efforts to begin producing truly person-centred pathways

There is much potential for further integration of HIV and hepatitis C testing in drug services, sexual health services and accident and emergency departments. Overcoming stigma has been identified as a major priority for promoting HIV testing and treatment. Learning from the progress made in addressing HIV stigma will benefit people with hepatitis C.


London Joint Working Group on Substance Use and Hepatitis C & Hepatitis C Trust. Routemap to eliminating hepatitis C in London: the opportunity. March 2020.