Dr Ashley BrownConsultant Hepatologist, St. Mary’s and Hammersmith Hospitals, London

and Honorary Senior Lecturer, Imperial College London

The Updated LJWG Consensus

Why update the 2011 consensus?

• Relevance in new NHS • In age of new treatments• In context of growing call for steps towards

elimination• To fit the current policy context in London

Since 2011

• Still not enough being done to join up services to help people access testing and treatment – Only 1 in 3 boroughs has testing-to-treatment

pathway– Some services in boroughs that reported having

pathway don’t know about it– 13 out of 33 boroughs made no mention at all of

hepatitis C in their Joint Strategic Needs Assessments or Joint Health and Wellbeing Strategies

London– largest city in the European Union – one of the most ethnically diverse

cities in the world– 40% of the London population

classified as non-white– many migrants come from parts

of the world with a high prevalence of hepatitis C

– a quarter of all those with hepatitis C in England live in London

– prevalence is higher than anywhere else in England

New treatments

New treatments, new opportunities – Models show that more effective treatments will reduce morbidity and

mortality by around 10-20% at current treatment rates

– If the number of people treated was also increased to 14% by 2018, then the effect would be an 85% reduction in mortality and a 90% reduction in decompensated cirrhosis by 2030, making the elimination of hepatitis C a real possibility.

– The combination of better drugs and improved uptake will have a significant impact on outcomes, and this should be done hand-in-hand with better harm reduction measures.

– A national scale-up in Scotland of harm reduction interventions (needle exchange, OST and a shift away from injecting) meant that between 2008 and 2012, 1,000 fewer Scottish injectors contracted hepatitis C.

Strategies to manage hepatitis C virus (HCV) disease burden, H. Wedemeyer et al Journal of Viral Hepatitis, 2014, 21, (Suppl. 1), 60–89 Palmateer et al Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions., PLoS ONE: 2014, 9(8): e104515.

What is it for?Consensus aims to reinforce the need for

– urgent leadership from the Department of Health, Public Health England and NHS England

– concerted action from Local Authorities, Health and Wellbeing Boards, Clinical Commissioning Groups (CCGs) and service providers

– to improve hepatitis C testing and treatment services in London for people with a history of using drugs – the group most affected by chronic hepatitis C – in order to find and treat significantly more people affected by the disease.

What is it for?• A starting point to stimulate discussions

among providers and commissioners • Evidence to lobby for resources and support• Ideas to inform service design

Available at ljwg.org.uk today!

The LJWG 2014 conference is funded through educational grants from AbbVie Ltd, Gilead Sciences Ltd and MSD Ltd

and sponsored by Bristol-Myers Squibb. None of the sponsors has had any control over the agenda or content.