Role for GPs in eliminating viral hepatitis

Dr Helen Jarvis, RCGP Clinical Champion for Liver Disease

In May 2016 the WHO set an ambitious new global target towards elimination of Viral Hepatitis by 2030 1. This was in part driven by the availability of new direct acting anti-viral (DAA) drugs to treat Hepatitis C (HCV), with up to 95% cure rates and minimal side effects. Although these DAA are some of the most expensive drugs ever licenced by NICE, they are deemed to be cost effective due to the huge health and economic burden of chronic HCV related liver cirrhosis, liver cancer, liver transplant and liver mortality. DAA are now first-line treatment for HCV in the UK. Along with the availability of these new drugs there has been a push in the UK towards improved case finding and treatment for people living with HCV.

Public Health England (PHE) produce an annual report on Hepatitis C in the UK, with latest figures in their 2017 report 2 estimating that there are 214,000 people living with chronic Hep C in the UK. Most of these people are from marginalised groups such as people who inject drugs (PWID). It is estimated that only 50% of PWID with chronic HCV in the UK are aware of their diagnosis.

Despite a growing consensus between policy makers, health economists, health systems leaders and patient advocates, there is concern that the UK is not on track to meet the HCV elimination by 2030 target. An All Party Parliamentary Group on Hepatology (APPGH) has picked up on this concern with the recent publication 'Eliminating Hepatitis C in England' in March 2018 3, which includes several suggestions around how GPs can contribute to this shared goal.

APPGH suggestions:

  1. Increased awareness of HCV among primary care professionals: there should be opportunities for GPs to readily access educational information as part of CPD with resources on hepatitis C being produced for primary care workers
  2. Testing should be widely available in primary care: plans to promote an annual HCV testing week
  3. In the medium-term GPs should be prescribing and delivering treatment directly 

The Liver Disease Clinical Priority Programme has recently launched an excellent on-line Toolkit on liver disease, including a detailed primary care focused article on HCV, with information on testing and treatment.

There are also links within the Toolkit to the latest NICE and SIGN guidelines on HCV. There are similar resources in the Toolkit on Hepatitis B virus (HBV), for which there is also a renewed global impetus towards elimination, primarily through improved prevention via vaccination.

The Hepatitis B universal infant vaccination programme was introduced in the UK in Autumn 2017, so an awareness of the changing epidemiology of HBV will be crucial for informed discussions, and to guide future testing decisions in primary care. The liver disease Toolkit also provides audit ideas which you may find useful to guide best practice in the way care is delivered to people at risk of viral hepatitis.

There are also links within the Toolkit to the excellent RCGP SMAH courses for more detailed learning on viral hepatitis.

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