Accelerating the Elimination of Hepatitis C in the UK

Aim To bring advances in experimental medicine to the clinic to accelerate the elimination of hepatitis C in the UK The objectives of the work are to: 1) Identify ongoing transmission of HCV through implementation of routine next generation viral sequencing in NHS services 2) Develop a clinical network to improve identification and treatment of recent HCV infection and underserved populations 3) Develop diagnostics for rapid delivery at point-of-care to improve linkage to care 4) Combine clinical and sequencing data to identify networks of transmission for targeting intervention Work planned as part of this application will : - Compare two methods for next generation sequencing (NGS) of hepatitis C (those developed by the STOPHCV and ICONIC consortia), against a standardized panel of isolates and existing methods of genotyping and, for the first time, implement one method into NHS practice for routine diagnosis to support identification of transmission networks. - Provide support to other centres wishing to introduce NGS sequencing into their service to develop capacity throughout the NHS. - Establish a multi-centre network to describe the cascade of care of individuals with recent hepatitis C infection. This will initially focus on People living with HIV (PLWH) where there is evidence of ongoing transmission driven by an overlap of high-risk sexual behaviour and injecting drug use. Detailed data will be collected to understand transmission risk behaviours (including sexual behaviours, use of recreational drugs, geographic location, barriers to treatment, linkage to care and treatment and outcomes of therapy, risks of reinfection). - Establish the feasibility of recruiting hepatitis C infected individuals presenting to secondary care into a clinical cohort to identify the proportion of those who are homeless or vulnerably housed and the barriers to accessing care and treatment - Develop new methodologies to diagnose active infection in seropositive individuals to address the challenges in linking newly diagnosed patients to care - For the first time in the UK, use a combination of data from above to describe networks of hepatitis C transmission across different areas and investigate whether transmissions are more likely to be detected at single centres or between centres to inform future interventions. Potential benefits to patients and the NHS The harmonization of approaches in different clinics towards recent hepatitis C infection will provide a standard of care which will be able to assess the performance of services and ensure the best care for individual patients. There has not until now been a unified effort to bring together clinical and epidemiological data and sequence across a network of clinics to understand transmission of hepatitis C. The information collected has the potential to provide important insights to inform policies for control where data is currently lacking and provide a rational basis for future intervention studies. During the period of this fellowship the relative importance of the marginalised populations that are the focus of this work will increase as hepatitis C treatment become more affordable and it become possible to cure all those individuals engaged in care. There will be a need for a better understanding of where new infections are happening and how to best prevent them. The information generated will provide evidence for new interventions to intervention. Despite scaling up access to treatment for hepatitis C, new infection rates have yet to fall and preventing further infection will save the costs of care and treatment to the NHS. This Professorship will enable the world leading scientific advances made by the UK HCV community to benefit all those with hepatitis and accelerate the elimination of HCV in the UK.