Research highlights

• Research provides strong evidence that hepatitis C infections can be eliminated.
• WHO adopts findings to create strategy for ending infections by 2030.
• Countries adopting WHO recommendations see cases fall significantly. 

Hepatitis C Virus (HCV) is a blood-borne infection that causes a serious risk to health through liver disease. Globally, HCV affects 71 million infected individuals and causes 400,000 deaths each year.

Over the last decade, researchers at the Faculty of Health Sciences have helped to reduce cases by defining effective and cost-effective interventions among vulnerable populations. Their work has also underpinned the development of global and national strategies that aim to eliminate HCV by 2030.  

Building the evidence 

Although HCV is a curable infection, provision of treatment has traditionally been low and not recommended among populations that are at risk of infection and re-infection – most notably people who inject drugs (PWID).  

This approach started to change when Professors Peter Vickerman and Matthew Hickman led a substantial body of research in the 2010s that included intervention studies, epidemiological analyses and systematic reviews.

Their work also included infectious disease and economic modelling that has transformed the evidence base for the prevention and treatment of HCV among PWID and other groups at risk of HCV transmission.  

The first big breakthrough came in 2017. The Bristol team produced strong new evidence that needle and syringe programmes and/or opioid substitution therapy can reduce the risk of HCV acquisition amongst PWID by over 50%. They also created models which showed that such programmes are already highly cost-effective in the UK and USA.  

Vickerman and Hickson then developed the first dynamic model of HCV transmission that illustrated the potential prevention impact of antiviral treatment – and, crucially, that treatment scale-up among PWID could eliminate HCV.  

They projected that the healthcare system in the UK only needs to treat 5-10% of PWID with chronic HCV each year to eliminate infection by 2030 and produced similar models for 11 countries in Europe and 21 countries worldwide.

The research also investigated the HCV epidemic among men who have sex with men and found that, among this group, HCV elimination is possible with an achievable scale up of HCV treatment.  

Impact on healthcare polices and patient health 

In the UK, Bristol’s modelling and evidence synthesis now underpins the National Institute for Health and Care Excellence’s (NICE) Public Health Guidance for HVC prevention.

It has also influenced recent recommendations outlining the crucial role of needle and syringe programmes and opioid substitution therapy for achieving HCV elimination in England, Scotland and Georgia - as well as plans to scale-up prevention in the US.   

The research on treatment has had a significant influence on international healthcare agencies and policy makers. In 2017, the World Health Organisation (WHO) commissioned modelling research from the University which formed part of the evidence it used to change its HCV treatment guidelines to a treat-all policy. T

hese new guidelines contrasted with prior guidance that had restricted HCV treatment to people based on disease stage. 

Bristol’s projection of possible HCV elimination was also crucial to the WHO’s proposal to end viral hepatitis as a major public health threat by 2030. The WHO’s strategy has subsequently influenced many countries to develop national HCV elimination initiatives – including Australia, Georgia, Pakistan and Scotland.  

These strategies, underpinned by the University of Bristol’s research, have already had a profound effect on the number of PWID who have been treated over time.

Cases of chronic HCV prevalence fell by 71% in a trial region in Scotland, by 42% in Australia and by 37% in Georgia – providing significant hope that elimination is possible and a model for other countries around the world to follow.