London needs to step up the rate of testing for hepatitis C
if it is to achieve elimination of hepatitis C, Professor Graham Foster of
Queen Mary University London told the London Joint Working Group on Substance
Use and Hepatitis C conference on hepatitis C elimination in London yesterday.
Although NHS England has exceeded its hepatitis C treatment
target – “no other European country has achieved that”, said Professor Foster – expanded
testing is the key to elimination, he said.
“We need to find people who started using drugs 30 or 40
years ago and don’t know they have it and are in real trouble – we need to
start doing GP testing.” He also endorsed greater promotion of online
self-testing services as a way of reaching people with a history of injecting drug
use.
“We also need to start testing people who drink alcohol in addiction
services – we have 4% prevalence in this group.”
“Local authorities really need to join us, step up and
commission more services. If you do more testing now, you will avoid spending
more money on treatment and care in the future.”
“We’re still not doing enough testing in drug services.
Everyone working in drugs services – including the receptionist – needs to be
able to do testing,” he said. The majority of new hepatitis C diagnoses are in
people who inject drugs and hepatitis C transmission is highly concentrated in
people who inject drugs and HIV-positive men who have sex with men in the
United Kingdom.
Emma Burke of Public Health England revealed that a survey
of local authorities in London shows major deficiencies in the provision of hepatitis
C testing in drug services. Six of 33 local authorities in the Greater London
area say no hepatitis C testing for clients of needle and syringe programmes is
taking place in their boroughs. In 23 of 33 boroughs, no testing is taking
place in pharmacies and in eight boroughs of 33, no HCV RNA testing for confirmation
of chronic hepatitis C infection is being done.
Dr Kevin Fenton of Lambeth, Southwark and Lewisham Health
Authority, Co-Chair of London HIV Fast-Track Cities, said that normalising HIV
testing among gay and bisexual men in London had been critical for increasing
the proportion of people with HIV on treatment and therefore unable to transmit
HIV.
But he questioned whether a pan-London advertising campaign to
encourage testing for hepatitis C is the best use of scarce resources. “Digital
micro-targeting can be a more efficient way of reaching the undiagnosed,” he said.
“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 Foster added.
Testing of migrants from countries with a high prevalence of
hepatitis C also needs to be revised, the conference heard. Dr Ashley Brown,
Consultant Hepatologist at St Mary’s and the Hammersmith Hospitals in west
London, said that 58% of people diagnosed with hepatitis C in west London were
born outside the United Kingdom – but they come from 104 countries. He argued
against country-specific testing, as practiced in some parts of London, instead
advocating testing all migrants over 40 years old, as “all [of the 58%] were
over 40.”