Establishing the cascade of care for hepatitis C in England—benchmarking to monitor impact of direct acting antivirals

R. Simmons*, G. Ireland, W. Irving, M. Hickman, C. Sabin, Samreen Ijaz, Mary Ramsay, S. Lattimore, Sema Mandal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Little is known about engagement and retention in care of people diagnosed with chronic hepatitis C (HCV) in England. Establishing a cascade of care informs targeted interventions for improving case finding, referral, treatment uptake and retention in care. Using data from the sentinel surveillance of blood-borne virus (SSBBV) testing between 2005 and 2014, we investigate the continuum of care of those tested for HCV in England. Persons ≥1 year old with an anti-HCV test and subsequent RNA tests between 2005 and 2014 reported to SSBBV were collated. We describe the cascade of care, as the patient pathway from a diagnostic test, referral into care, treatment and patient outcomes. Between 2005 and 2014, 2 390 507 samples were tested for anti-HCV, corresponding to 1 766 515 persons. A total of 53 038 persons (35 190 men and 17 165 women) with anti-HCV positive were newly reported to SSBBV. An RNA test was conducted on 77.0% persons who were anti-HCV positive, 72.3% of whom were viraemic (RNA positive) during this time period, 21.4% had evidence of treatment and 3130 49.5% had evidence of a sustained virological response (SVR). In multivariable models, confirmation of viraemia by RNA test varied by age and region/test setting; evidence of treatment varied by age, year of test and region/test setting; and SVR varied by age, year of test and region/setting of test. In conclusion, our findings provide HCV cascade of care estimates prior to the introduction of direct acting antivirals. These findings provide important baseline cascade estimates to benchmark progress towards elimination of HCV as a major public health threat.

Original languageEnglish
Pages (from-to)482-490
Number of pages9
JournalJournal of Viral Hepatitis
Issue number5
Publication statusPublished - May 2018

Bibliographical note

Funding Information:
Funding information The research received funding from the National Institute for Health Research Health Protection Research Unit [NIHR HPRU] in Blood-Borne and Sexually Transmitted Infections at UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine, and also from NIHR PHP (PR-R5-0912-13002 & 13001) Evaluation of interventions designed to increase diagnosis and treatment of patients with hepatitis C virus infection in primary care and drug treatment settings (HEPCATT). The NIHR HPRU in Blood-Borne and Sexually Transmitted Infections Steering Committee: Caroline Sabin (Director), Anthony Nardone (PHE Lead), Catherine Mercer, Gwenda Hughes, Jackie Cassell, Greta Rait, Samreen Ijaz, Tim Rhodes, Kholoud Porter, Sema Mandal and William Rosenberg. The Gastrointestinal and Liver Disorders Theme, NIHR Nottingham Biomedical Research Centre, and the NIHR HPRU in Evaluation. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health or Public Health England.

Publisher Copyright:
© 2017 Crown copyright. Journal of Viral Hepatitis © 2017 John Wiley & Sons LtdThis article is published with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.

Copyright 2018 Elsevier B.V., All rights reserved.


  • SVR
  • barriers
  • cascade
  • treatment


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