EPIToPe: Evaluating the Population Impact of Hepatitis C Direct Acting Antiviral Treatment as Prevention for People Who Inject Drugs


National Institute for Health (NIHR) Programme Grants for Applied Research (PGfAR) Ref. RP-PG-0616-20008

What is the research question?

Does scaling-up Hepatitis C Virus (HCV) treatment among People Who Inject Drugs (PWID) reduce HCV prevalence and transmission in the population?

What is the problem?

An estimated 200,000 people in the UK have been infected with the Hepatitis C Virus (HCV), which is an important cause of liver disease, cancer and death. Most HCV infections in the UK are in people who inject drugs. New HCV drugs cure over 90% of patients within 12 weeks with few side-effects, but are expensive (over £20,000) and currently restricted to people with moderate or severe liver disease. Mathematical models suggest that HCV “Treatment as Prevention”, i.e. treating people who inject drugs and have mild liver disease for HCV, can reduce the overall number of new HCV infections in the population, even though some people who inject drugs may also become re-infected. Further, if HCV treatment is increased sufficiently, then HCV will eventually be “eliminated” from the UK population. The findings from these models need to be tested out in patients.

What is the aim of the research?

The findings from these models of HCV need to be tested out in patients. This study will investigate if treating people who inject drugs and have mild liver disease for HCV can reduce HCV in this population.

How will this be achieved?

In the first study, our target is to treat at least 500 people who inject drugs in Dundee/NHS Tayside over two years. This large rapid increase in HCV treatment will be delivered across multiple sites in the community, including pharmacies, addiction services, and prisons. We estimate that this will reduce chronic HCV in people who inject drugs in Dundee by two-thirds from nearly 30% to less than 10%. To measure changes in HCV in the population, we need to increase the data available from surveys of people who inject drugs in Tayside and the rest of the UK, and develop novel statistical methods that can provide unbiased estimates of whether HCV has changed over time.

We will interview services providers in Dundee/NHS Tayside to identify key barriers and facilitators that can help other sites successfully scale-up HCV treatment. We will interview patients following treatment, and link to administrative databases to assess if being cured from HCV also helps people who inject drugs stay in specialist drug treatment and recover from addiction. We also will estimate whether the increase in HCV treatment to people who inject drugs is cost-effective to the NHS.

Finally, as the number of HCV treatments increase in England, we will co-design a second and larger evaluation of HCV “Treatment as Prevention” with regional HCV clinical services. We will use evidence gathered from our first study to show how we can scale-up HCV treatment in the community, and determine whether HCV infections reduce more in sites with greater scale-up than in sites with less intense scale-up of HCV treatment.

Who is leading the research?

Prof Matt Hickman, Professor in Public Health and Epidemiology, Population Health Sciences, University of Bristol.

Further information:


For more information or to get involved in this project, please contact bnssg.research@nhs.net.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.