Hepatitis C Action Plan
The Scottish Hepatitis C Action Plan has been cited as an example of best practice by the WHO, the European Commission and the United Nations Drug Policy Unit.
Faced with an estimated 38,000 people who had a chronic infection of viral hepatitis, most of whom (approximately 90%) had injected drugs, the Scottish government fully launched its Hepatitis C Action Plan in 2008. The objective of the Plan was to reduce the anticipated disease burden due to the virus.
Scotland aims to fulfil the elimination goal at the latest by 2024, which is six years earlier than the target set by the WHO. With its more rapid approach, Scotland seeks to ensure that fewer people will be sick or die from hepatitis C and follow-on diseases, such as liver cancer or failure. In addition, it is estimated that the overall costs to the health system are less, if elimination is reached earlier than 2030.
The success of Scotland’s HCV Action Plan is closely linked to the leadership and investment provided by the Scottish government, as well as the early and continued involvement of different stakeholders. The plan is three-fold, seeking to
- improve services to prevent the transmission of infection,
- identify those infected and
- ensure that diagnosed patients receive treatment.
- There was a 45% reduction in the number of people living with chronic hepatitis C from 38,000 to 21,000
- A 55% reduction in the number of people unaware of their infection from 23,500 to 10,500
- An increase in the diagnosis of infected people from 38% in 2006 to 50% in 2017 (this figure does not even take into account the thousands of people who were diagnosed and successfully treated, and, thus, are no longer living with hepatitis C.)
- Treatment of approximately 16,000 patients of whom 12,800 (80%) have been cleared of the virus
When a HCV cure became available as of 2014:
- New presentations of HCV related liver failure declined by 67% from a peak of 141 (in 2013) to 47 in 2018
- New presentations of HCV related liver cancer declined by 69% from a peak of 58 in 2016 to 18 in 2018
- HCV related deaths declined 49% from a peak of 67 in 2015 to 34 in 2018
The cooperation of a broad range of stakeholders was essential for establishment and successful implementation of the Action Plan. This stakeholder cooperation not only included public health and clinical experts, as well as different healthcare specialists and providers, but also patient representatives, and those with experience of working with people on the margins of society.
Scotland has managed to create a highly developed HCV service infrastructure: Its trained workforce is guided by nationally agreed guidelines, standards and targets, and functions in a coordinated and integrated way across different disciplines and agencies both within and outside the healthcare system.
Furthermore, its monitoring systems are tried, tested and robust. Since its inception, the champions of the Action Plan were clear that a robust evidence base was needed to both convince policymakers of the imperative need for action and, later on, to assess progress made. The evidence and data thus generated, helped to inform a large number of internationally acclaimed research projects on prevention, diagnosis and access to care.
The Action Plan received dedicated funding (£15 million) annually between 2009 and 2015, in addition to other general NHS funds.