Research and analysis

Hepatitis C in London annual report 2025

Updated 8 October 2026

Introduction

Hepatitis C virus (HCV) is a bloodborne virus. Chronic infection can lead to liver cirrhosis, end-stage liver disease and liver cancer. Prevention and treatment efforts have been combined to combat HCV infection and progress toward elimination of HCV as a public health threat by 2030 (set out in the World Health Organization Global Health Sector Strategy on Viral Hepatitis). The National Strategic Group on Viral Hepatitis, a cross-agency expert advisory body supported by the UK Health Security Agency (UKHSA), provides strategic guidance on viral hepatitis in England, and supports progress toward achieving the World Health Organization (WHO) goal of HCV elimination.

UKHSA publishes a national Hepatitis C in England report which summarises England’s progress towards the WHO elimination targets for HCV infection. This regional spotlight report complements the ‘Hepatitis C in England’ report and presents further information on HCV disease surveillance, and trends in HCV diagnosis, testing and treatment in the London UKHSA region with data up to the end of 2024.

For more details about data sources, see Information on data sources.

Summary

Key findings for hepatitis C testing:

• there were 4,552 new laboratory reports of hepatitis C in residents of the London UKHSA region in 2024, representing a rate of 50.1 reports per 100,000 population
• the number of new laboratory reports has increased by 11.2% since 2023 and increased by 13.1% over the past 10 years
• in 2024, the number of positive laboratory reports by local authority of residence ranged from 20 in Sutton to 455 in Camden. Rates were highest in Hammersmith and Fulham (219.4) and lowest in Sutton (9.3)
• in 2024, the number of laboratory reports in males was 2,495 (55% of reports) and in females was 1,309 (29%). Sex was unknown in 16% of cases
• in 2024, the highest number of laboratory reports was in males aged 45 to 54 and females aged 65 and over
• there were 598,822 individuals tested for anti-HCV in sentinel laboratories in the London UKHSA region in 2024, of whom 0.4% tested positive. The positive proportion was higher for tests referred from general practitioner (GP) surgeries, lower for tests from sexual health services, and higher for tests from drug services; the total number of tests conducted has likely increased since 2022 as a result of a new ‘opt-out’ bloodborne virus testing programme at selected emergency departments

Key finding for hepatitis C treatment pathway:

• of 12,442 individuals with chronic hepatitis C linked to specialist treatment services (via the NHSE Hepatitis C Patient Registry and Treatment Outcome System and/or NHSE’s Blueteq System), 12,017 started treatment within 90 days and 10,582 achieved a sustained viral response (SVR), in the London UKHSA region between 2015 and 2024

Key findings for HCV-related morbidity and mortality:

• there were 143 hospital admissions for individuals with a diagnosis code for hepatitis C-related end-stage liver disease or hepatitis C-related hepatocellular carcinoma in the London UKHSA region in 2024; with an upper-bound estimate of up to 174 admissions. This was lower than in 2023 (hospital admissions: 199)
• there was a lower bound estimate of 62 registered deaths from hepatitis C-related end‑stage liver disease and/or hepatocellular carcinoma in the London UKHSA region in 2024; with an upper‑bound estimate of up to 119 deaths. This was higher than in 2023 (lower bound estimated deaths: 52)

Trends in HCV testing and diagnosis in the general population and risk groups

New laboratory-confirmed diagnoses of hepatitis C

Figure 1. Number of new laboratory reports of hepatitis C, residents of London UKHSA region, 2015 to 2024

Data source: Second Generation Surveillance System (SGSS). For more information, see Information on data sources.

Note 1: in 2022, a new bloodborne virus (BBV) testing programme was introduced in selected emergency department (ED) sites in areas of very high and high human immunodeficiency virus (HIV) diagnosed prevalence across England. This programme expanded to other areas of high HIV prevalence in the second phase of the implementation of this programme, starting in 2024, however, not all UKHSA regions had participating ED sites within their areas.

Figure 1 shows the number of new laboratory reports of hepatitis C in London from 2015 to 2024. In 2024, 4,552 new laboratory reports of HCV were reported in London. This is an increase in reports from the previous year, and the highest number in the time period shown. Numbers of laboratory reports of HCV in London have been rising year on year since 2020, when numbers fell to the lowest after a period of decreasing laboratory reports from 2016.

Figure 2. Rate per 100,000 population of new laboratory reports of hepatitis C, residents of London UKHSA region and England, 2015 to 2024

Data sources: SGSS and Office for National Statistics (ONS) mid-year population estimates (MYE). For more information, see Information on data sources.

Note 2: the error bands represent 95% confidence intervals.

Figure 2 shows the trend in rate of new laboratory reports of hepatitis C in London per 100,000 residents compared to England overall. The rate of new laboratory reports of HCV in London in 2024 was 50.1 per 100,000 population, significantly higher than the national rate (28.3 per 100,000). The rate has been increasing since 2020, having previously been on a downward trend since 2016.

Table 1. Number and rate per 100,000 population of new laboratory reports of hepatitis C by UKHSA region of residence and England, 2015 to 2024

Area		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
East Midlands	Count	963	1,079	1,124	1,341	1,345	709	971	1,027	870	1,345
East Midlands	Rate	20.6	22.8	23.5	27.8	27.8	14.6	19.9	20.8	17.4	26.6
East of England	Count	1,105	1,291	1,131	1,039	1,072	773	1,092	997	815	929
East of England	Rate	16.6	19.2	16.7	15.3	15.7	11.3	15.8	14.3	11.5	12.9
London	Count	4,026	4,177	3,432	3,146	2,634	2,438	2,702	3,533	4,093	4,552
London	Rate	46.5	47.8	39.1	35.6	29.6	27.5	30.7	39.8	45.5	50.1
North East	Count	216	228	390	750	967	700	903	1,071	777	888
North East	Rate	8.3	8.7	14.9	28.5	36.7	26.5	34.1	39.9	28.5	32.2
North West	Count	2,935	2,625	2,485	3,467	2,964	1,462	2,782	2,693	2,826	2,767
North West	Rate	40.9	36.3	34.2	47.4	40.3	19.8	37.5	35.8	37.0	35.8
South East	Count	1,581	1,818	1,436	1,445	1,491	1,216	1,749	2,140	2,277	1,781
South East	Rate	18.8	21.4	16.8	16.8	17.3	14.0	20.1	24.3	25.5	19.7
South West	Count	1,147	1,065	1,105	994	957	913	842	947	1,035	1,400
South West	Rate	21.0	19.3	19.8	17.7	17.0	16.1	14.7	16.4	17.8	23.8
West Midlands	Count	1,090	1,371	1,198	1,118	1,305	922	1,221	1,141	794	1,161
West Midlands	Rate	18.9	23.6	20.5	19.0	22.0	15.5	20.5	19.0	13.0	18.8
Yorkshire and Humber	Count	1,812	1,483	1,423	1,608	1,665	1,035	1,314	1,258	1,243	1,514
Yorkshire and Humber	Rate	33.7	27.4	26.2	29.5	30.5	18.9	24.0	22.7	22.2	26.7
England	Count	14,916	15,182	14,517	16,195	15,864	10,630	14,116	15,217	15,432	16,590
England	Rate	27.2	27.5	26.1	29.0	28.2	18.9	25.0	26.6	26.6	28.3

Data sources: SGSS and Office for National Statistics (ONS) mid-year population estimates (MYE). For more information, see Information on data sources.

Note 3: data was not available to assign a case to a UKHSA region in 253 cases, meaning that the sum of all regional cases may not equal the number of England cases.

Table 1 shows the numbers and rates per 100,000 population of new laboratory reports of hepatitis C for each region in England from 2015 to 2024. In 2024, London was the region with the highest number and rate of laboratory reports, followed by the North West.

Table 2. Number and rate per 100,000 population of new laboratory reports of hepatitis C by local authority of residence, 2015 to 2024

Area		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Barking and Dagenham	Count	26	42	57	40	44	39	53	56	90	58
Barking and Dagenham	Rate	12.6	19.9	26.6	18.5	20.1	17.8	24.2	25.4	39.8	24.9
Barnet	Count	80	111	89	103	70	60	75	134	133	143
Barnet	Rate	21.2	29.0	23.2	26.6	17.9	15.3	19.3	34.3	33.4	35.3
Bexley	Count	26	22	28	35	6	8	17	16	42	47
Bexley	Rate	10.8	9.0	11.5	14.3	2.4	3.2	6.9	6.5	16.7	18.3
Brent	Count	115	128	93	82	60	73	59	93	104	88
Brent	Rate	34.3	37.7	27.2	23.7	17.3	21.2	17.4	27.2	29.8	24.9
Bromley	Count	28	49	42	51	61	44	46	32	32	42
Bromley	Rate	8.6	15.0	12.8	15.4	18.4	13.3	13.9	9.7	9.6	12.5
Camden	Count	348	254	227	173	144	594	646	617	555	455
Camden	Rate	157.4	114.9	103.7	79.4	66.3	276.6	306.2	283.9	255.5	209.7
Croydon	Count	80	82	96	89	77	72	69	70	54	57
Croydon	Rate	21.0	21.3	24.9	23.0	19.7	18.4	17.7	17.8	13.4	13.9
Ealing	Count	171	154	121	110	120	63	97	203	196	293
Ealing	Rate	47.6	42.5	33.4	30.2	32.7	17.1	26.4	54.8	51.7	75.9
Enfield	Count	41	66	62	53	73	46	59	108	97	101
Enfield	Rate	12.4	19.8	18.6	15.9	21.8	13.8	17.9	33.0	29.6	30.8
Greenwich	Count	87	88	86	89	79	49	59	59	157	196
Greenwich	Rate	31.7	31.6	30.5	31.1	27.4	17.0	20.4	20.2	53.0	65.4
Hackney and City of London	Count	108	110	121	85	83	46	51	64	113	198
Hackney and City of London	Rate	40.1	40.3	44.4	31.0	30.2	16.9	19.0	23.4	40.5	70.2
Hammersmith and Fulham	Count	298	397	360	247	177	131	121	206	297	414
Hammersmith and Fulham	Rate	159.1	211.8	191.8	130.7	93.9	70.2	66.0	110.9	158.4	219.4
Haringey	Count	59	35	68	76	71	44	27	67	80	84
Haringey	Rate	21.6	12.7	24.8	27.7	25.9	16.3	10.2	25.6	30.4	31.8
Harrow	Count	49	116	109	64	41	40	28	53	45	70
Harrow	Rate	19.2	45.1	42.3	24.6	15.6	15.3	10.7	20.2	16.9	25.9
Havering	Count	7	25	50	62	42	30	28	65	100	105
Havering	Rate	2.8	9.8	19.4	23.9	16.1	11.5	10.7	24.5	37.0	38.0
Hillingdon	Count	139	121	86	63	65	49	63	90	130	190
Hillingdon	Rate	47.3	40.7	28.7	20.8	21.3	16.0	20.6	28.8	40.4	57.7
Hounslow	Count	122	99	83	58	73	51	72	121	181	191
Hounslow	Rate	44.3	35.5	29.5	20.3	25.2	17.6	25.0	41.8	61.3	63.8
Islington	Count	155	169	105	77	47	33	50	68	96	90
Islington	Rate	71.0	76.6	47.4	34.8	21.2	14.9	23.0	30.9	43.2	40.4
Kensington and Chelsea	Count	285	164	112	90	59	39	58	64	89	89
Kensington and Chelsea	Rate	182.5	107.4	74.8	60.6	40.2	26.9	40.2	43.7	60.8	61.6
Kingston upon Thames	Count	0	17	32	42	25	28	18	27	34	23
Kingston upon Thames	Rate	0.0	10.1	19.0	24.9	14.7	16.5	10.7	16.0	19.9	13.3
Lambeth	Count	287	295	214	242	169	103	124	133	247	93
Lambeth	Rate	88.9	90.3	65.4	73.6	51.3	31.6	39.0	41.9	77.5	29.3
Lewisham	Count	71	85	121	123	85	63	111	124	113	111
Lewisham	Rate	24.0	28.4	40.2	40.6	27.8	20.7	37.0	41.4	37.6	36.8
Merton	Count	25	12	40	53	46	22	23	44	33	39
Merton	Rate	11.7	5.6	18.6	24.5	21.2	10.1	10.7	20.5	15.2	17.8
Newham	Count	169	191	120	111	114	81	92	122	121	211
Newham	Rate	51.2	57.0	35.5	32.2	32.6	23.1	26.2	34.1	32.9	56.3
Redbridge	Count	132	140	69	48	50	30	39	38	109	103
Redbridge	Rate	43.9	46.0	22.6	15.5	16.0	9.6	12.6	12.2	34.4	32.1
Richmond upon Thames	Count	21	31	48	26	39	18	33	35	51	43
Richmond upon Thames	Rate	10.8	15.8	24.4	13.2	19.7	9.1	16.9	17.9	26.0	21.9
Southwark	Count	122	163	103	125	115	137	117	293	268	125
Southwark	Rate	40.1	53.1	33.5	40.3	36.8	43.9	38.1	94.7	85.5	39.7
Sutton	Count	39	38	39	32	36	25	32	34	35	20
Sutton	Rate	19.4	18.7	19.0	15.5	17.3	11.9	15.3	16.2	16.5	9.3
Tower Hamlets	Count	226	200	125	164	153	125	150	175	142	369
Tower Hamlets	Rate	80.0	69.2	42.6	54.7	50.2	40.7	48.0	53.9	43.1	111.2
Waltham Forest	Count	187	193	80	76	86	55	73	62	67	87
Waltham Forest	Rate	68.1	69.7	28.8	27.2	30.6	19.7	26.2	22.5	24.1	31.1
Wandsworth	Count	299	371	226	194	183	167	124	142	133	149
Wandsworth	Rate	92.7	113.7	68.6	58.6	54.7	50.0	37.8	43.0	39.8	44.1
Westminster	Count	222	199	212	225	141	73	88	118	143	253
Westminster	Rate	102.8	93.3	100.7	107.2	67.7	35.5	42.8	56.4	67.9	120.5
Local authority unknown	Count	2	10	8	38	0	0	0	0	6	15
Local authority unknown	Rate	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
England	Count	14,916	15,182	14,517	16,195	15,864	10,630	14,116	15,217	15,432	16,590
England	Rate	27.2	27.5	26.1	29.0	28.2	18.9	25.0	26.6	26.6	28.3

Data sources: SGSS and Office for National Statistics (ONS) mid-year population estimates (MYE). For more information, see Information on data sources.

Note 4: data was not available to assign a case to a UKHSA region in 253 cases, meaning that the sum of all regional cases may not equal the number of England cases. Local authority data was available for almost 100% of cases where region data was available in London.

Table 2 shows the numbers and rates per 100,000 population of new laboratory reports of hepatitis C in London by local authority from 2015 to 2024. In 2024, the local authority with the highest rate of reports was Hammersmith and Fulham (219.4 per 100,000) followed by Camden (209.7 per 100,000). Westminster and Tower Hamlets also had rates above 100 per 100,000 population.

Figure 3. Age group and sex of new laboratory reports of hepatitis C, residents of London UKHSA region, 2024

Data source: Second Generation Surveillance System (SGSS). For more information, see Information on data sources.

Figure 3 shows the age-sex distribution of new laboratory reports of hepatitis C in London in 2024. The groups with the most cases were males aged 35 to 44 and males aged 45 to 54. In all age groups there were more cases in males than females, with males making up 66% of all reports where data on sex was available.

Figure 4. Ethnicity distribution of new laboratory reports of hepatitis C, residents of London UKHSA region, 2015 to 2024

Data source: SGSS. For more information, see Information on data sources.

Note 5: this figure excludes cases of unknown ethnicity. (30% of reports had no ethnicity recorded).

Note 6: where the number of cases in an ethnic group in a given year is between 1 and 4 (inclusive), data has been suppressed for disclosure control. Suppressed values are shown as an asterisk (*) on the chart.

Figure 4 shows the proportion of new laboratory reports by ethnic group in London from 2015 to 2024. In 2024 the ethnic group with the highest percentage of hepatitis C reports was Any other White background at 27%, followed by White British (24%) and Asian or Asian British (21%). Data on ethnicity was available for only 57% of laboratory reports in 2024.

HCV testing in the wider population

Figure 5. Number of individuals tested for anti-HCV by year and percentage positive in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Note 7: trend data only includes testing laboratories that have consistently reported over time. Results from laboratories that report results on an inconsistent or temporary basis are excluded so as not to skew trends.

Note 8: in 2022, a new bloodborne virus (BBV) testing programme was introduced in selected emergency department (ED) sites in areas of very high and high human immunodeficiency virus (HIV) diagnosed prevalence across England. This programme expanded to other areas of high HIV prevalence in the second phase of the implementation of this programme, starting in 2024, however, not all UKHSA regions had participating ED sites within their areas.

Note 9: the error bands represent 95% confidence intervals.

Figure 5 shows the number of individuals tested for anti-HCV in sentinel laboratories in London, and the percentage positive from 2015 to 2024. In 2024, the number of individuals tested was 598,822. The number of individuals tested has been rising since 2020, when numbers fell to their lowest since 2015 likely due to the impact of the COVID-19 pandemic. The percentage positive was 0.45% in 2024. This has been on a downward trend since 2017.

Figure 6. Number of individuals tested for anti-HCV by year and percentage positive, through GP surgeries, in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Note 10: trend data only includes testing laboratories that have consistently reported over time. Results from laboratories that report results on an inconsistent or temporary basis are excluded so as not to skew trends.

Note 11: the error bands represent 95% confidence intervals.

Figure 6 shows the number of individuals tested for anti-HCV in sentinel laboratories through GP surgeries in London, and the percentage positive from 2015 to 2024. In 2024, the number of individuals tested was 39,143. The number of individuals tested has been rising since 2020, when numbers fell to their lowest since 2015 likely due to the impact of the COVID-19 pandemic. The percentage positive was 0.46% in 2024. This has been on a downward trend since 2016.

Figure 7. Number of individuals tested for anti-HCV by year and percentage positive, through sexual health services, in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Note 12: trend data only includes testing laboratories that have consistently reported over time. Results from laboratories that report results on an inconsistent or temporary basis are excluded so as not to skew trends.

Note 13: the error bands represent 95% confidence intervals.

Figure 7 shows the number of individuals tested for anti-HCV in sentinel laboratories through sexual health services in London, and the percentage positive from 2015 to 2024. In 2024, the number of individuals tested was 26,392. The number of individuals tested increased between 2020 and 2023 but fell slightly in 2024. The percentage positive was 0.17% in 2024. This has been on a downward trend since 2016.

Figure 8. Number of individuals tested for anti-HCV by year and percentage positive, through drug services, in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Note 14: trend data only includes testing laboratories that have consistently reported over time. Results from laboratories that report results on an inconsistent or temporary basis are excluded so as not to skew trends.

Note 15: the error bands represent 95% confidence intervals.

Figure 8 shows the number of individuals tested for anti-HCV in sentinel laboratories through drug services in London, and the percentage positive from 2015 to 2024. In 2024, the number of individuals tested was 5,889. The number of individuals tested was on an upward trend from 2015 until 2023 but fell in 2024. The percentage positive was 17% in 2024. This has been relatively stable since 2016.

Figure 9. Number of individuals tested for anti-HCV by year and percentage positive, through emergency departments, in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Note 16: trend data only includes testing laboratories that have consistently reported over time. Results from laboratories that report results on an inconsistent or temporary basis are excluded so as not to skew trends.

Note 17: in 2022, a new bloodborne virus (BBV) testing programme was introduced in selected emergency department (ED) sites in areas of very high and high human immunodeficiency virus (HIV) diagnosed prevalence across England. This programme expanded to other areas of high HIV prevalence in the second phase of the implementation of this programme, starting in 2024, however, not all UKHSA regions had participating ED sites within their areas.

Note 18: the error bands represent 95% confidence intervals.

Figure 9 shows the number of individuals tested for anti-HCV in sentinel laboratories through emergency departments in London, and the percentage positive from 2015 to 2024. In 2024, the number of individuals tested was 400,929. The number of individuals tested has been rising steeply since 2021, likely due to the implementation of opt-out blood-borne virus testing. The percentage positive was 0.22% in 2024. This has been on a general downward trend since 2015, latterly, as expected with the roll-out of opt-out testing.

Figure 10. Percentage positivity for anti-HCV tests by setting or reason for test in sentinel laboratories 2020 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Numbers next to bars indicate the number of positive cases in 2020 to 2024.

Note 19: percentage positive is calculated using the number of individuals tested per year per speciality. If an individual has multiple tests in a year across multiple specialities, then they will be counted once per speciality.

Figure 10 shows the percentage of tests positive in each speciality in sentinel laboratories in London from 2020 to 2024. The speciality with the highest positivity was drug services (16.9%) followed by community outreach (12.2%).

Figure 11. Percentage of individuals testing anti-HCV positive among those tested in sentinel laboratories, by operational delivery network (ODN), 2020 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Numbers next to bars indicate the number of positive cases.

Note 20: ODN boundaries do not fully align with UKHSA regional boundaries, so not all London residents may be captured within the highlighted bars. Bars are highlighted in the above chart based on the region containing the majority of their residents. Consequently the highlighted bars may include cases from outside the region, and some residents of this region may fall into ODNs / highlighted bars associated with other regions.

Figure 11 shows the percentage positive for anti-HCV among individuals tested in sentinel laboratories by operational delivery network (ODN) from 2020 to 2024. The ODN with the highest positivity in England was South Yorkshire (30.2%) followed by South West Peninsula (18.4%). The London ODN with the highest positivity was North Central London (2.8%).

Figure 12. Percentage of individuals tested positive for HCV RNA in sentinel laboratories in London UKHSA region, 2015 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Figure 12 shows the trend in proportion of individuals testing positive for HCV RNA in sentinel laboratories in London from 2015 to 2024. In 2024 positivity was 7.3%, the lowest in the time period shown. Positivity has been on a downward trend since 2016.

Figure 13. Percentage of individuals testing HCV RNA positive among those tested in sentinel laboratories, by operational delivery network (ODN), 2020 to 2024

Data source: SSBBV. For more information, see Information on data sources.

Numbers next to bars indicate the number of positive cases.

See note 20.

Figure 13 shows the percentage of individuals who tested positive for HCV RNA among those tested in sentinel laboratories by operational delivery network (ODN) from 2020 to 2024. The ODN with the highest positivity in England was South West Peninsula (39.5%) followed by Surrey Hepatitis Services (37%) and Leicester (36.4%). The London ODN with the highest positivity was North Central London (18.6%).

Testing and diagnosis in people who inject drugs (PWID)

Figure 14. Percentage of Unlinked Anonymous Monitoring (UAM) Survey participants with evidence of ever being infected with HCV (anti-HCV), London UKHSA region and England, 2015 to 2024

Data sources: Unlinked Anonymous Monitoring (UAM) survey. For more information, see Information on data sources.

Note 21: during 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 is combined.

Figure 14 shows data from the Unlinked Anonymous Monitoring (UAM) Survey on the proportion of people who inject drugs (PWID) with evidence of ever being infected with HCV (anti-HCV) in London, and England, between 2015 and 2024.

In 2024, the proportion of PWID with evidence of ever having been infected with HCV (anti-HCV) in London was 56%, slightly higher than in 2023 (54%) and higher than that for England (52%). Between 2015 and 2024, the proportion fluctuated but remained higher than that reported for England throughout the period, returning to levels reported in 2015.

Figure 15. Percentage of Unlinked Anonymous Monitoring (UAM) Survey participants ever infected with HCV who have chronic HCV infection, London UKHSA region and England, 2015 to 2024

Data sources: Unlinked Anonymous Monitoring (UAM) survey. For more information, see Information on data sources.

Note 22: during 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 is combined.

Figure 15 shows data from the UAM Survey on the prevalence of chronic HCV infection among people who inject drugs (PWID) in London and England between 2015 and 2024.

The prevalence of chronic HCV infection among PWID in London was 7% in 2024, lower than the previous year (2023: 11%) and lower than that for England (10%). Following a peak of 61% in 2016, chronic HCV prevalence in London declined to its lowest level in 2024 and has remained below that reported for England since 2018.

Figure 16. Percentage of Unlinked Anonymous Monitoring (UAM) Survey participants who self-reported being recently (current or previous year) tested for HCV, London UKHSA region and England, 2015 to 2024

Data sources: Unlinked Anonymous Monitoring (UAM) survey. For more information, see Information on data sources.

Note 23: during 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 is combined.

Figure 16 shows data from the UAM Survey on the proportion of people who inject drugs who self-reported being recently (current or previous year) tested for HCV in London and England between 2015 and 2024.

In 2024, the proportion of PWID reporting a recent HCV test in London was 54%, a small increase compared to 2023 (52%) and slightly higher than that for England (53%). Overall, testing uptake in London increased between 2015 and 2024 and has been similar to that reported for England over recent years.

Hepatitis C treatment pathway

Reinfections in individuals initiating treatment

Figure 17. Treatment pathway in London UKHSA region, 2015 to 2024

Data source: SSBBV, NHS England (NHSE) Hepatitis C Patient Registry and Treatment Outcome System, NHSE Blueteq System. For more information, see Information on data sources.

Note 24: in individuals testing hepatitis C virus RNA or core antigen positive with no linkage to the Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System, there are no time restrictions on a subsequent RNA or core antigen negative test after the initial RNA or core antigen positive test. Therefore, these individuals may include those that have spontaneous clearance of their infection or individuals who have cleared infection as a result of treatment but were not linked to the NHSE Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System.

Note 25: in the absence of a reported SVR as a treatment outcome in the NHSE Hepatitis C Patient Registry and Treatment Outcome System, an RNA or core antigen negative test recorded at 96 days or more after the treatment start date in SSBBV was used.

Definitions of the numerator and denominator for each metric shown in the treatment pathway are provided in Table 3 of the Technical Notes.

Figure 17 shows the hepatitis C treatment pathway in London between 2015 and 2024.

Between 2015 and 2024, 77.7% of individuals with chronic hepatitis C were linked to treatment, and of these, 96.6% started treatment. Overall treatment coverage was 75.1%, below the WHO elimination target for treatment coverage (≥80%). Treatment outcomes were available for 94.2% of individuals who started treatment, and among those with a reported outcome, 93.5% achieved sustained virological response (SVR). Among all individuals who started treatment, 88.1% had evidence of SVR.

Treatment pathway by operational delivery network (ODN)

1) Barts ODN

Figure 18. Treatment pathway by operational delivery network (ODN) in Barts ODN, 2015 to 2024

Data source: SSBBV, NHSE Hepatitis C Patient Registry and Treatment Outcome System, NHSE Blueteq System. For more information, see Information on data sources.

Note 26: in individuals testing hepatitis C virus RNA or core antigen positive with no linkage to the Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System, there are no time restrictions on a subsequent RNA or core antigen negative test after the initial RNA or core antigen positive test. Therefore, these individuals may include those that have spontaneous clearance of their infection or individuals who have cleared infection as a result of treatment but were not linked to the NHSE Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System.

Note 27: in the absence of a reported SVR as a treatment outcome in the NHSE Hepatitis C Patient Registry and Treatment Outcome System, an RNA or core antigen negative test recorded at 96 days or more after the treatment start date in SSBBV was used.

Note 28: ODN boundaries do not fully align with UKHSA regional boundaries, so not all London residents may be captured in these ODN charts. ODN charts are presented within this report for the region containing the majority of their residents. Consequently, these charts may include cases from outside the region, and some London residents may be in ODNs falling in other regions, and so be included in other regions’ reports.

Definitions of the numerator and denominator for each metric shown in the treatment pathway are provided in Table 3 of the Technical Notes.

Figure 18 shows the hepatitis C treatment pathway for Barts Operational Delivery Network between 2015 and 2024. 

Between 2015 and 2024, 73.1% of individuals with chronic hepatitis C were linked to treatment, and of these, 95.0% started treatment. Overall treatment coverage was 69.4%, below the WHO elimination target for treatment coverage (≥80%). Treatment outcomes were available for 91.6% of individuals who started treatment, and among those with a reported outcome, 97.4% achieved sustained virological response (SVR). Among all individuals who started treatment, 89.3% had evidence of SVR.

2) North Central London ODN

Figure 19. Treatment pathway by operational delivery network (ODN) in North Central London ODN, 2015 to 2024

Data source and notes: see Figure 18.

Figure 19 shows the hepatitis C treatment pathway for North Central London Operational Delivery Network between 2015 and 2024.

Between 2015 and 2024, 77.9% of individuals with chronic hepatitis C were linked to treatment, and of these, 96.5% started treatment. Overall treatment coverage was 75.2%, below the WHO elimination target for treatment coverage (≥80%). Treatment outcomes were available for 92.7% of individuals who started treatment, and among those with a reported outcome, 93.8% achieved sustained virological response (SVR). Among all individuals who started treatment, 86.9% had evidence of SVR.

3) South Thames Hepatitis Network ODN

Figure 20. Treatment pathway by operational delivery network (ODN) in South Thames Hepatitis Network ODN, 2015 to 2024

Data source and notes: see Figure 18.

Figure 20 shows the hepatitis C treatment pathway for South Thames Hepatitis Operational Delivery Network between 2015 and 2024.

Between 2015 and 2024, 77.8% of individuals with chronic hepatitis C were linked to treatment, and of these, 96.3% started treatment. Overall treatment coverage was 74.9%, below the WHO elimination target for treatment coverage (≥80%). Treatment outcomes were available for 93.5% of individuals who started treatment, and among those with a reported outcome, 91.2% achieved sustained virological response (SVR). Among all individuals who started treatment, 85.4% had evidence of SVR.

4) West London ODN

Figure 21. Treatment pathway by operational delivery network (ODN) in West London ODN, 2015 to 2024

Data source and notes: see Figure 18.

Figure 21 shows the hepatitis C treatment pathway for West London Operational Delivery Network between 2015 and 2024.

Between 2015 and 2024, 81.1% of individuals with chronic hepatitis C were linked to treatment, and of these, 97.8% started treatment. Overall treatment coverage was 79.3%, below the WHO elimination target for treatment coverage (≥80%). Treatment outcomes were available for 97.1% of individuals who started treatment, and among those with a reported outcome, 93.8% achieved sustained virological response (SVR). Among all individuals who started treatment, 91.1% had evidence of SVR.

Reinfections in individuals initiating treatment

For people who initiated treatment between 2015 and 2024 in London, the reinfection rate was 3.4 per 100 person-years (95% CI 3.1 to 3.8), which was lower than the England estimate (6.5 per 100 person-years, 95% CI 6.3 to 6.7). Among those who had injected drugs within the 3 years prior to treatment initiation, the reinfection rate was 4.8 per 100 person-years (95% CI 4.2 to 5.4), again lower than the England estimate (8.8 per 100 person-years, 95% CI 8.5 to 9.0). For individuals whose last injection was more than 3 years earlier, the rate was 2.9 per 100 person-years (95% CI 2.5 to 3.3), again lower than the England estimate (4.0 per 100 person-years, 95% CI 3.8 to 4.2). Among people with any history of imprisonment before starting treatment, the reinfection rate was 5.8 per 100 person-years (95% CI 4.8 to 6.9), also lower compared with England (9.4 per 100 person-years, 95% CI 9.0 to 9.7).

Monitoring HCV-related morbidity

Hospital admissions from HCV

Figure 22. Number of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), London UKHSA region and England

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2025, reused with the permission of NHS England. All rights reserved. For more information, see Information on data sources.

Note 29: estimates of incidence of hepatitis C-related ESLD and/or HCC are not available for 2017 and 2018. This is due to an interruption in the supply of identifiers by NHS Trusts in tax year April 2017 to March 2018.

Note 30: data for 2024 is provisional and figures for previous years are subject to change as a result of late reporting and the associated de-duplication procedure.

Note 31: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 32: data based on HES as of December 2025.

Figure 22 shows the estimated number of first hospital admissions among London residents with hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) between 2010 and 2024. Data for 2017 and 2018 are unavailable.

In 2024, the estimated number of first hospital admissions for hepatitis C-related ESLD and/or HCC was between 143 and 174, lower than the estimated range reported in 2023 (199 to 236). Overall, the estimated number of first admissions has been declining since 2015, reaching its lowest level in 2024. Estimated numbers have also been declining in England since 2016.

Figure 23. Rate per 100,000 of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), London UKHSA region and England

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2025, reused with the permission of NHS England. All rights reserved. For more information, see Information on data sources.

Note 33: estimates of incidence of hepatitis C-related ESLD and/or HCC are not available for 2017 and 2018. This is due to an interruption in the supply of identifiers by NHS Trusts in the 2017 to 2018 tax year.

Note 34: data for 2024 is provisional and figures for previous years are subject to change as a result of late reporting and the associated de-duplication procedure.

Note 35: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 36: data based on HES as of December 2025.

Figure 23 shows the rate per 100,000 population of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) among London residents between 2010 and 2024. Data for 2017 and 2018 are unavailable.

In 2024, the estimated rate of first hospital admissions for hepatitis C-related ESLD and/or HCC was between 1.57 and 1.91 per 100,000 population, lower than the estimated rate range reported in 2023 (2.21 to 2.62). Overall, the estimated rate was relatively stable until 2015 before declining, reaching its lowest level in 2024. Historically (pre-2014) estimated rates were higher in London than England overall but more recently (including in 2024) were lower.

HCV-related mortality

Figure 24. Number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), London UKHSA region, 2005 to 2024

Data source: ONS Mortality and ONS MYE. For more information, see Information on data sources.

Figure 24 shows the estimated number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) among London residents between 2005 and 2024.

In 2024, the estimated number of deaths was between 62 and 119, higher than the estimated range in 2023 (52 to 107). The estimated number of deaths peaked around 2014 to 2016 before declining and then stabilising somewhat over recent years.

Figure 25. Mortality rate per 100,000 population for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) by UKHSA region, 2020 to 2024

Data source: ONS Mortality and ONS MYE. For more information, see Information on data sources.

Figure 25 shows the mortality rate per 100,000 population for hepatitis C-related end- stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) mapped by region between 2020 and 2024.

London had the highest mortality rate (1.94 per 100,000 population), significantly higher than England overall (1.31 per 100,000). The North West reported the second highest rate (1.90 per 100,000), while the East of England had the lowest rate (0.90 per 100,000 population).

Prevention of infection by harm reduction

Figure 26. Reported level of direct sharing of needles/syringes among people who inject drugs (PWID), in the preceding 4 weeks, London UKHSA region and England, 2015 to 2024

Data sources: Unlinked Anonymous Monitoring (UAM) survey, see Information on data sources.

Note 37: during 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 is combined.

Figure 26 shows the reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks in London and England between 2015 and 2024.

Direct sharing refers to self-reported sharing of needles and syringes among people who had injected in the 4 weeks preceding survey participation and indirect sharing refers to self-reported sharing of injecting equipment other than needles and syringes.

In 2024, the reported level of direct needle and/or syringe sharing amongst PWID in London was 7.1%, a decrease from 12.2% in 2023 and significantly lower than that reported for England (24.8%). This was the lowest level reported during the period. Overall, the reported level peaked in 2019 before declining and has remained significantly below that reported for England since 2020.

Figure 27. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID), in the preceding 4 weeks, London UKHSA region and England, 2015 to 2024

Data sources: Unlinked Anonymous Monitoring (UAM) survey, see Information on data sources.

Note 38: during 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 is combined.

Figure 27 shows the reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID) in the preceding 4 weeks in London and England between 2015 and 2024.

In 2024, the reported level of direct and indirect sharing of injecting equipment in London was 22.4%, a decrease from 24.2% in 2023 and significantly lower than that reported for England (44.4%). This was the lowest level reported during the period. Overall, the reported level declined by 13.4 percentage points, from 35.8% in 2015 to 22.4% in 2024, and remained below that reported for England throughout the period.

Information on data sources

Second Generation Surveillance System (SGSS)

Brief description

SGSS captures routine laboratory surveillance data on infectious diseases and antimicrobial resistance from laboratories within England. Along with a number of other organisms, hepatitis C is notifiable under the Health Protection (Notifications) Regulations (2010).

Technical notes

Laboratory reports of new diagnoses of HCV include positive test results for anti-HCV and HCV-RNA tests and are submitted to UKHSA or predecessor organisations via SGSS/CoSurv.

Data is assigned to local authority and UKHSA region by patient postcode where present. If patient postcode is unknown, data is assigned to the local authority and UKHSA region of registered general practice. Where both patient postcode and registered general practice are unknown, data is assigned to the local authority and UKHSA region of laboratory.

Dates are assigned based on earliest positive specimen date. Patient-identifiable data submitted by NHS laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to deduplicate.

Laboratory reports for children under 1 year of age are excluded from the analyses to rule out detecting maternal antibody. Rates per 100,000 have been calculated using mid-year population estimates (MYE) supplied by the Office for National Statistics (ONS).

Caveat: SGSS data in this report may differ from data shown in the Hepatitis C in England report and from data reported in other surveillance outputs at a different point in time. This is due to the SGSS dataset being a live system and a number of cleaning, deduplication, remapping and other operational processes being routinely applied to the data to improve data quality.

Data extracted from Sentinel Surveillance of bloodborne virus testing (SSBBV) and SGSS will vary for several reasons and should not be compared: the 2 systems have collected data over different historical periods, with data reported to SGSS and predecessor systems since 1995, whereas SSBBV has been running since 2002. Data reported to SSBBV reflects the timeframe from when the laboratory joined the surveillance system, with laboratories joining more recently having less data available than laboratories who have been reporting since 2002. Furthermore, whilst SGSS collects national level data, SSBBV collects data from a subset of laboratories. Currently, 35 laboratories report to SSBBV with an estimated 45% coverage testing in the GP-registered population in England.

Finally, it is not possible to differentiate a previous or current infection in SGSS with limited HCV RNA or HCV Ag data available, therefore numbers presented will be a mixture of previous and current infections. However, SSBBV allows for the collection of all HCV markers enabling HCV antibody and HCV RNA or HCV Ag to be presented separately.

Sentinel Surveillance of Bloodborne Viruses (SSBBV)

Brief description

SSBBV is a sub-national surveillance system for BBV testing activity and results in England, managed by UKHSA. Established in 2002, it includes data on all positive and negative BBV tests processed by the sentinel laboratories that participate in SSBBV. Laboratory participation in SSBBV is voluntary, and currently represents approximately 45% of the GP registered population in England. SSBBV includes the 2 laboratories that process DBS tests for the major drug services in England. Therefore, it is likely that the data covers most tests coming from drug services, where DBS is the main method of testing.

Technical notes

Patient identifiable data submitted by laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to de-duplicate. Data is de-duplicated subject to availability of date of birth, Soundex, NHS number and first initial. The proportion positive is calculated using the number of people tested.

For trends in hepatitis C antibody testing, SSBBV data is from 35 laboratories and is based on complete and consistent reporting since 2015 to remove any artificial increases or decreases in testing due to changes in reporting. This
means that the numbers of laboratories included for trend data may change each year depending on their reporting history. A positive test result first reported by participating laboratories may not reflect an individual’s first diagnosis.

Antibody testing excludes samples collected outside routine testing such as look back studies, reference testing, and children aged one year and under, whereas RNA or core antigen testing includes reference testing.

Reinfection

In England, 2 criteria have been used to identify hepatitis C virus reinfection, either of which would establish a person as experiencing reinfection:

• individuals with a positive hepatitis C virus RNA test at least 196 days (28 weeks) after treatment start date among those with a SVR during their first treatment period
• individuals who have a subsequent period of treatment after an initial SVR, and where this subsequent treatment period was at least 196 days after first treatment start date

For both definitions SVR is defined as either a recorded SVR or proxy SVR from a negative RNA or core antigen result after treatment. A period of 196 days between first treatment and reinfection diagnosis is used to define reinfection as the majority of individuals receiving treatment will have cleared hepatitis C virus within 6 months (182 days). A further 2 weeks (14 days) is added to account for any delays in treatment initiations. Reinfection after spontaneous clearance is not included.

The estimate now includes multiple reinfections, whereby someone is treated after experiencing their first reinfection and achieves an SVR but then has a subsequent hepatitis C virus RNA or core antigen positive result. The data is reliant upon persons initiating treatment being added to the NHSE Blueteq System or NHSE Hepatitis C Patient Registry and Treatment Outcome System, sufficient identifiers being available to link between the treatment and SSBBV databases and on people being tested post treatment. It should be noted that there is no internationally agreed definition for defining hepatitis C reinfection and a different window period may be used to confirm SVR post treatment. For example, Scotland uses a negative test between 10 weeks and 12 months post treatment to confirm SVR. As we progress toward elimination of hepatitis C virus as a public health threat, ongoing work across the UK will aim to harmonise definitions of reinfection where possible and utilise multiple methods, including the use of whole genome sequencing, to better understand reinfection.

Hospital Episode Statistics (HES)

Brief description

New cases of hepatitis C-related ESLD and/or HCC are monitored using HES for incidence of ESLD and HCC, and HES and SGSS for hepatitis C diagnoses. This is a new method in 2025 which presents data as a sensitivity analysis with upper and lower bounds, mirroring the updated methodology for deaths from hepatitis C-related ESLD and/or HCC. New cases are identified by first linking all episodes of ESLD and/or HCC in HES for an individual using their unique patient identifier. These are classified as ‘new’ if no previous episodes of ESLD and/or HCC for that individual are found in at least the previous 5 years (less than 1% of HCC and/or ESLD episodes are estimated to have had a previous episode more than 5 years earlier).

Linkage to hepatitis C diagnoses uses the following 2 methods:

1. Lower bound: linkage to episode of hepatitis C in HES for all years: first diagnosis of ESLD and/or HCC linked to hepatitis C diagnosis in HES for any year. First diagnosis of ESLD and/or HCC used data from 2003 to 2024 to give minimum 5-year window for first episode starting at 2010. Hepatitis C diagnosis started from 1 April 2000 onwards. Hepatitis C includes both acute and chronic cases.
2. Upper bound: linkage to diagnoses of hepatitis C in HES or surveillance data for all years: first diagnosis of ESLD and/or HCC linked to earliest diagnosis of hepatitis C in any of HES or SGSS.

Due to the loss of identifiers in HES data for 2017, data for 2017 and 2018 is omitted. More information is available in Appendix 3 of Hepatitis C in England 2022.

Hepatitis C Treatment Pathway data

Brief description

Hepatitis C treatment initiation data is used to monitor access to hepatitis C treatment. Treatment coverage is defined as the proportion of individuals diagnosed with chronic hepatitis C (hepatitis C virus RNA or hepatitis C core antigen test positive) and who initiated treatment during a specified time frame over the number of individuals diagnosed with chronic hepatitis C for the specified time period.

Technical notes

Records from individuals with a diagnosis of chronic hepatitis C reported through SSBBV (positive hepatitis C virus RNA or antigen tests) are linked to the NHSE Hepatitis C Patient Registry and Treatment Outcome System using NHS number, name, date of birth (DOB), hospital number and NHSE’s Blueteq System using NHS number, DOB, Blueteq number, and excludes children aged under one year.

Patient identifiable data submitted by SSBBV laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to link data sets or de-duplicate. Data is de-duplicated subject to availability of DOB, Soundex, NHS number and first initial. Data quality is assessed on an ongoing basis to verify the number of people who tested positive for hepatitis C virus RNA or core antigen. As individuals are followed through the care pathway, the denominator is updated to exclude people who have died or who have evidence of spontaneous clearance.

In individuals testing hepatitis C virus RNA or core antigen positive with no linkage to the Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System, there are no time restrictions on a subsequent hepatitis C virus RNA or core antigen negative test after the initial RNA or core antigen positive test. Therefore, these individuals may include those that have spontaneous clearance of their hepatitis C virus infection or individuals who have cleared their hepatitis C virus infection as a result of treatment but were not linked to the NHSE Hepatitis C Patient Registry and Treatment Outcome System or NHSE’s Blueteq System.

The NHSE Hepatitis C Patient Registry and Treatment Outcome System was commissioned by NHSE in 2017 from the Arden and Greater East Midlands Commissioning Support Unit to capture more detailed information for patients. The hepatitis C virus treatment monitoring in England report summarises the data held within the registry and Treatment Outcome System up to the end of April 2018.

Table 3. Definitions of the numerator and denominator for metrics reported in the hepatitis C treatment pathway

Metric	Numerator	Denominator
Proportion of individuals diagnosed with chronic hepatitis C who were linked to specialist treatment services	Number of individuals linked to specialist hepatitis C treatment services via ODNs (identified through successful linkage to the NHSE Hepatitis C Patient Registry and Treatment Outcome System and/or NHSE’s Blueteq System).	Number of individuals who tested positive for hepatitis C virus RNA or core antigen with NHS number or name and date of birth (DOB) reported through SSBBV who had not died before linkage to treatment and where there was no evidence of possible spontaneous clearance.
Proportion of individuals linked to specialist treatment services who initiated treatment	Number starting treatment.	Number of individuals linked to specialist hepatitis C treatment services via ODNs.
Proportion of individuals diagnosed with chronic hepatitis C who initiated treatment (WHO target)	Number starting treatment.	Number of individuals who tested positive for hepatitis C virus RNA or core antigen with NHS number or name and DOB reported through SSBBV who had not died before linkage to treatment and where there was no evidence of possible spontaneous clearance.
Proportion of individuals who initiated treatment who had an outcome reported or had an RNA or core antigen test reported through SSBBV	Number of individuals who had a treatment outcome reported via the NHSE Hepatitis C Patient Registry and Treatment Outcome System, or in the absence of a recorded outcome, an RNA or core antigen test (positive or negative) recorded at 96 days or more after the treatment start date in SSBBV.	Number of individuals who started treatment.
Proportion of individuals who initiated treatment and were reported to have achieved SVR either as a treatment outcome or had an RNA or core antigen negative result reported through SSBBV	Number clearing hepatitis C virus as a treatment outcome, or in the absence of a reported SVR, an RNA or core antigen negative test recorded at 96 days or more after the treatment start date in SSBBV. The proportion reported as clearing hepatitis C virus is likely to be lower than the true proportion.	Number starting treatment.
Proportion of individuals who initiated treatment and had an outcome reported or an RNA or core antigen test reported through SSBBV who were reported to have achieved SVR or had an RNA or core antigen negative test result	Number clearing hepatitis C virus as a treatment outcome, or in the absence of a reported SVR, an RNA or core antigen negative test recorded at 96 days or more after the treatment start date in SSBBV.	Number of individuals with a treatment outcome recorded or with an RNA or core antigen test (positive or negative) recorded at 96 days or more after the treatment start date in SSBBV.

Office for National Statistics (ONS) Mortality data

Brief description

The number of hepatitis C virus-related deaths are used to measure mortality. Deaths are based on the year of death. International Classification of Diseases (ICD) tenth revision (ICD-10) codes for ESLD and HCC are used to identify deaths with ESLD or HCC as a cause or associated with hospital admissions for these conditions. The number of deaths was estimated using slightly different ICD-10 codes from those used by WHO. A comparison of the codes used can be found in the Hepatitis C in England 2022 report.

Technical notes

An updated method for estimating deaths from hepatitis C-related ESLD and/or HCC has been used for this report. The previous method of reporting that solely used death data from the Office for National Statistics (ONS) was shown to underestimate mortality rates from hepatitis C-related liver disease by up to 60%. To address this, an updated method is used that presents the estimated mortality attributable to hepatitis C as a range. The lower bound of this range is similar to the previous methodology using only ONS death registration data, while the upper bound uses ONS death registration data linked to data on hospital episode statistics (HES) data on viral hepatitis, ESLD and/or HCC and laboratory data on viral hepatitis diagnoses. The updated methodology has been applied to all previous years, and includes deaths by year of death rather than by year the death was registered as was previously used.

Lower bound represents deaths where ESLD and/or HCC and hepatitis C were reported in ONS death registration data (as year of death is now used this is not comparable with previously published estimates which used year the death was registered). Upper bound represents deaths where ESLD and/or HCC were reported in ONS death registrations or identified in HES hospital admissions data linked to deaths data, and hepatitis C diagnoses were identified by linking between ONS deaths, HES hospital admissions data and laboratory diagnosis data to yield a maximum number of deaths attributable to hepatitis C-related ESLD and/or HCC. Excluding deaths of people aged under 16 and deaths registered in England where the deceased’s usual residence is outside England. ESLD is defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Unlinked Anonymous Monitoring (UAM)

Brief description

The voluntary UAM survey recruits people who have ever injected psychoactive drugs through specialist services (such as needle and syringe programmes and addiction treatment centres) across England, Wales and Northern Ireland. Those who agree to take part self-complete a questionnaire and provide a biological specimen that is tested anonymously for HIV, hepatitis B and hepatitis C.

Technical notes

Regional level data from the UAM survey should be interpreted cautiously as the survey recruits participants through a nationally reflective sample of the services provided to people who inject drugs.

The COVID-19 pandemic, and associated changes in service delivery, impacted on recruitment to the survey in 2020 and 2021. By 2022, the number of services taking part in the survey, and the number of participants was comparable to pre-pandemic levels.

Published regional-level data and more information can be found at People who inject drugs: HIV and viral hepatitis monitoring.

Acknowledgements

We would like to thank the following:

• local laboratories for supplying the hepatitis data
• the UKHSA Blood Safety, Hepatitis, STI and HIV Division for collection, analysis and distribution of data
• the UKHSA Epidemiology Data Science unit (part of the Epidemiology Data Science team) for producing the charts and figures contained in this report
• the Office for National Statistics (ONS), which carried out the original collection and collation of the mid-year population estimates, death registration data and geographic boundary data but bears no responsibility for their future analysis or interpretation)
• the Hospital Episode Statistics (HES), NHS England, produced by UKHSA

About Field Services

Field Services is a division within UKHSA that provides a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Public Health Microbiology, Rapid Investigation, Real-time Syndromic Surveillance, Field Epidemiology Training, and Data Science to strengthen the surveillance, epidemiological intelligence and response functions of UKHSA.

You can contact your local Field Services team at FES.SEaL@ukhsa.gov.uk

If you have any comments or feedback regarding this report or the Field Services, please contact FS.Central@ukhsa.gov.uk