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Background:
The NHS England HCV Elimination Programme fostered partnerships between drug and alcohol services, the NHS and the pharmaceutical industry. ARC Hounslow, a CNWL-led NHS community drug and alcohol treatment service, collaborated with Hep C U Later, Chelsea & Westminster Hospital, West London ODN, the Hepatitis C Trust, and Gilead Sciences to achieve and sustain micro-elimination through enhanced testing and access to treatment.
Model of Care:
ARC Hounslow launched an HCV elimination programme in 2020 to identify and test patients at risk of HCV transmission, offering treatment to those diagnosed within the service rather than in hospital. New patients were assessed for transmission risk and tested, with annual re-testing for those with ongoing risk of HCV transmission. A micro-costing economic model was developed to assess implementation and ongoing maintenance costs, and long-term cost-effectiveness.
Effectiveness:
By 2023, ARC Hounslow achieved and sustained micro-elimination. The service managed ~1,000 patients annually (2019–2024), with 41% being new to treatment and 15–25% having a history of injecting. By 2023, all patients with an injecting history had a known HCV status, with nearly all HCV+ patient treated and cured. Elimination criteria were met service-wide (Figure 1). The programme was determined to be cost-effective using the micro-costing model, inclusive of administration, assessment, testing, linkage to care, treatment, and adherence support. Long-term system savings offset these costs through reduced liver-related events and fibrosis treatment expenses over a lifetime horizon. Patients also gained additional life years and improved quality-adjusted life years.
Conclusion and Next Steps:
ARC Hounslow demonstrated that a comprehensive testing and partnership model enables successful and sustained HCV micro-elimination. This approach not only reduces morbidity but also proves cost-effective in the long term.
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