Working in partnership to achieve hepatitis C elimination

The nurse clinic room at Cambridge’s Change Grow Live drug treatment service (DTS) does not look like a place where patients are assessed. It’s homely – somewhere people can feel better about themselves.

On the walls of the small room are brightly coloured slogans: “Be your own kind of beautiful”; “Be amazing”; “Everything is possible if you believe in yourself”.

Combined with the staff’s obvious sincerity, these sentiments feel uplifting, rather than patronising. “We want to be warm and welcoming,” says Ben Jones, cluster lead nurse. “We don’t judge. We don’t assume.”

This inclusive and non-judgemental approach towards some of our society’s most marginalised people is how the Cambridgeshire DTS is leading one of the health service’s greatest achievements of the past decade: the near elimination of hepatitis C (HCV).

England is on track to be one of the first countries to achieve the World Health Organization (WHO) 2030 goal of eliminating HCV as a public health threat. This progress is underpinned by a nationally coordinated elimination programme led by NHS England. Since 2019, Gilead Sciences has worked in partnership with NHSE and with drug treatment services such as Change Grow Live to support the transformation of hepatitis C testing, treatment and care.

“It’s a unique approach,” says Peter Wickersham, Gilead Sciences’ vice president and general manager, UK and Ireland. “This doesn’t occur in other countries.”

Mr Wickersham tells the Change Grow Live team how “impressed” he is by the work they’re doing, and how important these site visits are to him as a leader: “I love the passion people here have. I get energy from coming out and meeting people – and I learn something every time.”

Encouraging results are visible

The partnership approach has transformed HCV testing, treatment and data infrastructure across DTS settings.

Progress has been encouraging. UK Health Security Agency (UKHSA) reports the proportion of people who inject drugs (the group at greatest risk of HCV) who have cleared HCV was 45.4 per cent in 2023, almost double 2015’s 23 per cent.

Pandemic lockdowns could have stalled this progress. But in 2020, in response to the disruption facing traditional DTS, Gilead helped to establish the Hepatitis C DTS Provider Forum, which brought together five of the largest third sector DTS providers, alongside 14 NHS trusts and The Hepatitis C Trust, to encourage collaboration and best practice sharing.

The forum subsequently adopted the concept of micro-elimination, which is defined as the elimination of HCV within a specific location or population, such as a DTS.

Change Grow Live Cambridgeshire achieved micro-elimination at the end of 2024. It did so by meeting key targets, including offering 100 per cent of clients an HCV test and commencing treatment with 90 per cent of patients with HCV. To date, 77 of England’s 149 partnered drug treatment centres have reached micro-elimination.

More than elimination: a catalyst for change

Ten years ago, people with chronic HCV had such a bleak outlook that people were afraid to be tested. Today, diagnosis and treatment can be a positive experience that triggers “motivation for change”, says Mr Jones. “People say, ‘I used to feel so fatigued. I have more energy now. I can focus.’”

The Change Grow Live team includes people with lived experience of drug addiction, and peer support is a core part of the service. “Bringing that lived experience in is vital,” says Mr Jones. “It helps to build trust. People share positive stories and have very open conversations.”

It’s a point reinforced by Pinda Garcha, senior patient access to care manager, Liver Business Unit, Gilead. “It’s a win. A lot of people in the [DTS] have had years of struggle and barriers,” he says. Experiencing success – clearing HCV and averting a potential health disaster, such as liver cancer or failure – can create a sense of self-worth that makes progress in other areas of life seem possible. “They get that springboard.”

Gilead’s involvement in the HCV elimination programme aligns with its commitment to bring new hope to people facing devastating diseases, including blood-borne viruses such as HCV and HIV, liver disease and cancer. But it also reflects the company’s commitment to addressing health inequities and improving access to care. Mr Wickersham emphasises that innovation counts for little if it never reaches the people in most need: “Innovative medicines only work when people are able to take them.”

Keeping elimination within reach

The outlook for HCV prevention and treatment among people who inject drugs has improved dramatically, but achieving micro-elimination status across all DTS – and maintaining it – will require ongoing commitment.

HCV elimination does not mean zero cases, and some infections and new transmissions will continue after the WHO goal has been achieved. Around one in three people who inject drugs report inadequate needle and syringe provision, leaving them vulnerable to new HCV infections and reinfections.

“Micro-elimination is not a destination,” says Mr Garcha. Rather, it is part of a “journey”.

“The job is not done,” says Mr Wickersham. But the systemic model for HCV elimination that has been developed in DTS is a success deserving celebration. It’s also one that has huge potential, he suggests.

Reflecting further on HSJ’s visit, Mr Wickersham adds: “With the elimination programme now reaffirmed as it moves into its next phase, Gilead will continue to work with our partners to ensure that people continue to be found, treated and supported until elimination is secured.”