Awareness of Hepatitis C Infection Among People Who Inject Drugs, England, Wales, and Northern Ireland

Author: Helen Dwyer, Holly Mitchell, Claire Edmundson, Jacquelyn Njoroge, Jennifer Gunther, Lababa Hasan, Manchari Rajkumar, Samreen Ijaz, Ross Harris, Monica Desai

Theme: Epidemiology & Public Health Research Year: 2023


Awareness of hepatitis C virus (HCV) infection status among people who inject drugs (PWID) is important to facilitate early diagnosis and to help support elimination. We investigated factors associated with awareness of HCV infection status among PWID to highlight missed opportunities.


Data were extracted from an annual cross-sectional survey of PWID in England, Wales, and Northern Ireland, where participants provided a blood sample and self-completed a questionnaire. Among participants with a current infection, characteristics were compared between those aware vs. unaware of their infection status from 2017-2021. Data include first participations only.


During 2017-2021, 59% of participants with a current infection (Ab+ RNA+) were unaware of their infection status, which significantly increased from 49% in 2017 to 71% in 2021. Of those who were unaware of their current infection, 35% were currently not injecting, 56% had their last HCV test over 2 years ago and 12% injected for the first time within the last three years (recent initiates).

Among participants with a current infection, after adjusting, recent initiates to injecting were significantly less likely to be aware of their infection compared to those who started injecting 4+ years ago (adjusted odds ratio (aOR) 0.67 95% CI: 0.45-0.99). Those who had a recent HCV test (current or previous year), were vaccinated for hepatitis B, or used a health service in the last year (excluding needle exchange and drug treatment) had greater odds of being aware of their infection (aOR: 1.71 95% CI: 1.36-2.15; aOR: 1.46 95% CI: 1.12-1.90; and aOR: 1.64 95% CI: 1.09-2.46; respectively).


With increased testing and treatment, the proportion of those aware of their chronic HCV infection is expected to decline. Targeted approaches, such as peer support, will be required to reach those remaining undiagnosed, including recent initiates and those currently not injecting.

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