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Hepatitis C prevention: ‘treat-all’ strategy is important but targeting people who inject drugs has the greatest benefit 

1 October 2019

Having a 'treat-all' policy for hepatitis C (HCV) infections will help prevent transmission of the disease globally but targeting treatment at people who inject drugs has the greatest benefit per treatment given, according to research led by the National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions at the University of Bristol

Hepatitis virus in infected organism

The researchers used mathematical modelling to look at how many HCV infections could be avoided with a ‘treat-all’ strategy, which is recommended in the World Health Organization’s (WHO) latest guidelines. They found that, globally, over a 20-year period, 0.35 infections could be prevented for each treatment given, or around one infection prevented for every three treatments.

The study, published in Journal of Viral Hepatitis, also looked at the number of infections that could be prevented if treatment was given to people who inject drugs, which was found to prevent 1.27 infections per treatment globally. 

Dr Adam Trickey, from the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, who was lead author of the study, said: “This study supports the WHO’s guidelines for a treat-all strategy, but also shows that most prevention benefit is achieved from treating people who inject drugs. Using treatment as prevention could be a useful tool for meeting the WHO’s target for eliminating HCV globally by 2030. We are pleased that this research has informed the development of the WHO guidelines.”

Professor Peter Vickerman, from the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, who supervised the study, said: “Direct‐acting antiviral treatments have made HCV an easily curable infection, leading to WHO setting elimination targets for 2030. Meeting the target will require governments to efficiently allocate resources for treating HCV infections, especially in countries where antiviral treatment costs are high or resources are low. Being clear about treatment strategies that will deliver the greatest prevention benefit is vital for governments making decisions about the best approach for their population.”

Hepatitis C is a virus that is passed on through blood exposure and results in liver disease. It is estimated that over 70 million people are infected with the hepatitis C virus worldwide and that around 400,000 people with hepatitis C die each year due to related conditions such as cirrhosis of the liver and liver cancer. 

Paper: Modelling the potential prevention benefits of a treat‐all hepatitis C treatment strategy at global, regional and country levels: A modelling study. Adam Trickey et al. Journal of Viral Hepatitis. August 2019.

Further information

About the NIHR HPRU in Evaluation of Interventions at the University of Bristol

The Health Protection Research Unit (HPRU) in Evaluation of Interventions, based in Population Health Sciences at the University of Bristol, is part of the National Institute for Health Research (NIHR) and a partnership between University of Bristol and Public Health England (PHE), in collaboration with University College London, Cambridge Medical Research Council (MRC) Biostatistics Unit and University of the West of England. We are a multidisciplinary team undertaking applied research on the development and evaluation of interventions to protect the public’s health. Our aim is to support PHE in delivering its objectives and functions. Our focus is on the PHE priority area of infection. Follow us on Twitter: @HPRU_EI 

About the NIHR

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.