This document represents a call to action from experts in the fields of addiction and hepatitis in London. It provides a framework with which to address the epidemiological, clinical and financial challenges presented by current rates of hepatitis C among people who have injected drugs and sets out solutions in the form of a blueprint for local commissioners.
Against the backdrop of a radically changing healthcare environment and increasingly limited resources, mortality associated with liver disease is rising dramatically in the UK. This stands in stark contrast to the four other major causes of death in this country, which affect fewer people at a later age than ever before, while liver disease affects growing numbers of increasingly younger people.
The cost to the NHS of liver disease is already at least £500m a year, and is rising by 10% annually. The main causes of liver disease are alcohol abuse, obesity and viral hepatitis. Of these, hepatitis C is the factor most amenable to intervention, through prevention strategies focused on education and awareness, and medical interventions with cost- effective, NICE-approved treatments.
In London an estimated 34,000 people with a history of injecting drugs have hepatitis C - yet only about 800 people (2%) a year receive treatment. Not only does this represent a major health inequality but it is also a false economy in terms of NHS resources. Current service provision is disjointed and patchy, so much so that even where individual services are performing well, gaps in the wider provision needed to treat drug users with hepatitis C continue to undermine their progress.
Action needs to be taken now to avert a major public health crisis. Education and awareness must be improved among workers and service users in drug services, prisons and other services in London. Integrated care pathways must be implemented to support access to treatment for larger numbers of people with hepatitis C and a history of injecting drugs. We believe this is the only way to address a significant heath inequality and prevent a massive future burden of disease in London.
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