This article has been developed and funded by Gilead Sciences

Hepatitis C elimination has brought great success but how can learnings be applied to HIV?

In 2022, the NHS announced its initiative to eliminate hepatitis C (HCV) had successfully cured around 84,000 people.1

This means by 2025, England could be one of the first countries globally to have eliminated HCV, five years ahead of the World Health Organization’s target.1,2

This truly is a medical success story and as we look to make similar advances across other blood borne viruses such as HIV, what are the learnings?

Inevitably, success across HCV owes much to the availability of curative medicines, however, the vision of eliminating the disease is being achieved through a collaboration that hinges on reaching marginalised communities most at risk – 89% of HCV infections occur among those with a recent or history of injecting drugs.3

Through a unique partnership between NHS England (NHSE), health service providers, the pharmaceutical industry and patient organisations, testing and treatment is now available to people where it is needed most, such as in drug treatment services and prisons.

Through this partnership and a series of Gilead-supported HCV initiatives, since 2019, there have been over 400,000 tests completed, nearly 12,500 treatment starts, and HCV has been micro-eliminated across over 50 drug treatment services and prisons nationally.

This achievement is noteworthy, especially considering the challenges posed by COVID. Through this strong partnership, it meant everyone could work together to adapt services during the pandemic, incorporating measures such as home testing, remote monitoring and targeted testing on homeless populations.

Mark Gillyon-Powell, Deputy Director – HCV Elimination & Health Inequalities, NHS England: “The HCV elimination programme in England has already found tens of thousands of people with hepatitis C and cured them of a life-threatening infection.”
He added: “As we approach the final stretch, the challenge becomes even harder, as we look for the remaining unknown cases. Our successes so far are a testament towards the effectiveness of working in partnership across industry and the third sector, and we will only reach our elimination goals through closer collaboration with our partners.”

Within HIV, in just three decades, we have moved from an era of saving lives to ending an epidemic.

A combination of science and community engagement led to earlier treatment, the concept of treatment as prevention, pre-exposure prophylaxis and key treatment innovations, such as the single tablet regimens and now long-acting options, as well as understanding an undetectable viral load means untransmissible (U=U) and people simply cannot pass HIV on to sexual partners.

Gilead has been there over the decades and we will continue to strive for a cure and even more effective treatment and prevention options. Options that meet the needs of the diverse communities impacted by HIV and to end new transmissions by 2030.

While England has made great progress towards ending new HIV transmissions, challenges in meeting those targets persist and progress is not equitable across all communities.

From experience, we believe the best way of improving patient outcomes and preventing new transmissions is by addressing community needs through genuine, trusted partnerships as seen in HCV.

Across government, healthcare, community organisations and industry, we must work as one community to listen, learn and together find tailored solutions to the challenges faced by those living with or at risk of HIV today.

One such challenge is the long-term retention in care of people living with HIV.

It’s vital to ensure that services are responsive to the needs of those most at risk, and often people such as women and men from Black communities, men who have sex with men (MSM), transgender, Latin American and heterosexual women, are at greater risk of living with transmissible levels of HIV.

Richard Angell, CEO of Terence Higgins Trust: “Even though we are trying to end HIV transmissions without a vaccine or a cure, the results of the HCV elimination strategy have been undeniably effective and inspires action in the cause of ending new HIV cases by the end of the decade.”

As with HCV, we can leave no one behind. Targeting most at-risk groups, developing educational and stigma-busting resources and training clinical professions is key, but the most effective way to tackle health inequalities in HIV and HCV is to put the test where the patient is already using the NHS.

Opt-out testing in Emergency Departments is a game changer. We are grateful for Gilead’s support in our campaign to expand the opt-out testing initiative.

It is only through all parties collaborating that the possibility of ending the HIV epidemic by 2030 can become the reality.

Through our medical and community engagement work at Gilead, we have worked with HCPs and community organisations to provide a range of educational materials and tools to help empower individuals to be actively involved in their care and connect to a wider support network to deliver the outcomes that matter to them.

hivfindyourfour.co.uk represents just one example of raising awareness of the broader holistic care required to live well with HIV. While our HCP led HIV in Focus podcast series cover a range of subjects relevant to HIV and non-HIV healthcare specialists.

We believe the kind of partnerships described can act as an agent of innovation in the NHS and are not limited to blood borne viruses. Industry has much to offer to the health system, including investment in digital and data solutions, resources and expertise to optimise care pathways.

This also encompasses investing in treatment as prevention and grant funding to enable third sector organisations to meet the needs of their communities.

Industry can support the NHS to pilot new approaches to care pathways or adopt new innovations into the health service. Where pilots are successful, industry can then support the NHS to scale up such partnerships for the benefit of patients.

The recent news that the Government has confirmed the expansion of the HIV opt-out testing programme in emergency departments in areas with high HIV prevalence is a great example of how true collaboration between companies such as Gilead, community organisations, government and the healthcare system can drive innovative service delivery in the NHS.

At Gilead, we are prepared to work proactively and innovatively towards healthcare equity and – in HIV specifically – it is vital we maintain momentum with all stakeholders as we strive to reach the 2030 target of eliminating transmissions.

References

1. NHS England. World Patient Safety Day 2023: How engaging patients has accelerated our progress towards hepatitis C elimination. Go to england.nhs.uk/blog/world-patient-safety-day-2023-how-engaging-patients-has-accelerated-our-progress-towards-hepatitis-c-elimination
2. NHS England. NHS set to eliminate Hepatitis C ahead of rest of the world. Go to england.nhs.uk/2022/12/nhs-set-to-eliminate-hepatitis-c-ahead-of-rest-of-the-world
3. UK Health Security Agency. Taking a place-based approach to tackling hepatitis in prisons. Go to ukhsa.blog.gov.uk/2023/05/11/taking-a-place-based-approach-to-tackling-hepatitis-in-prisons
4. GOV.UK. Policy Paper – Towards Zero – An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England – 2022 to 2025. Go to gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-england-2022-to-2025/towards-zero-an-action-plan-towards-ending-hiv-transmission-aids-and-hiv-related-deaths-in-england-2022-to-2025