Research and analysis

Hepatitis C in the East of England 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 towards 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 more information on HCV disease surveillance, and trends in HCV diagnosis, testing and treatment in the East of England UKHSA region with data up to end of 2024.

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

Summary

Key findings for hepatitis C testing:

• in 2024, there were 929 new laboratory reports of hepatitis C in residents of the East of England UKHSA region (EoE), representing a rate of 12.9 reports per 100,000 population. This is below the national rate of new laboratory reports of hepatitis C of 28.3 per 100,000 population. Across the UKHSA regions, the East of England has the lowest rate of new laboratory reports of hepatitis C
• the number of new laboratory reports has increased by 14.0% in 2024 compared with 2023 but decreased by 15.9% over the past 10 years
• in 2024, the number of positive laboratory reports by upper tier local authority of residence ranged from 5 in Central Bedfordshire to 167 in Suffolk. Among upper tier local authorities, the rate of positive laboratory reports was highest in Peterborough at 47.8 per 100,000 population and lowest in Central Bedfordshire with 1.6 per 100,000 population
• in 2024, the number of laboratory reports in males was 397 (42.7%) and in females was 218 (23.5%), while sex was unknown in 33.8% of cases. In 2024, the highest numbers of laboratory reports were in males aged 35 to 44 and females aged 45 to 54
• 42,027 individuals were tested for anti-HCV in sentinel laboratories in the East of England in 2024, of which 2.5% tested positive. This is a marked increase from 32,001 individuals tested in 2023. The increase predates the roll-out of opt-out testing in emergency departments in March 2025, but can be attributed to multiple initiatives to increase testing across primary, secondary and outreach care

Key findings for hepatitis C treatment pathway:

• of 5,875 individuals with chronic hepatitis C linked to specialist treatment services using a recorded NHS number or name and date of birth via the NHSE Hepatitis C Patient Registry, 5,672 (96.5%) started treatment within 90 days; 5,019 (88.5%) achieved a sustained viral response (SVR), in the East of England between 2015 and 2024
• the 5,672 individuals who started treatment represents 84.0% of individuals with chronic hepatitis C, meeting the WHO elimination target for treatment coverage (≥80%)

Key findings for HCV-related morbidity and mortality:

• the number of first hospital admissions for individuals with a diagnosis code for hepatitis C-related end-stage liver disease or hepatitis C-related hepatocellular carcinoma is estimated to be between 96 and 116 in the East of England in 2024. This was higher than in 2023 when the estimate was between 83 and 96
• the number of registered deaths from hepatitis C-related end-stage liver disease and/or hepatocellular carcinoma was estimated to be between 23 and 53 in the East of England in 2024. This was higher than the lower estimate of 17 in 2023 but overlaps with the upper estimate of 43

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

New laboratory-confirmed diagnoses of HCV

Figure 1. Number of new laboratory reports of hepatitis C, residents of East of England 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. In the East of England, there are 8 ED sites included in the second phase of the BBV opt-out programme but roll-out was started in March 2025 so data for this period will not have been included yet in this report.

The number of new laboratory reports of hepatitis C in the East of England fluctuated between 2015 and 2024, with a marked decline in 2020, most likely due to reduced testing during the pandemic. The number of new laboratory reports of HCV among residents of the East of England rose from 815 in 2023 to 929 in 2024 (Figure 1). The long-term trend in new laboratory reports of HCV among residents of the East of England from 2015 to 2024 shows a gradual decline since the peak of 1,291 cases in 2016.

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

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

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

In 2024, the rate of new laboratory reports of HCV, among residents of the East of England rose from 11.5 per 100,000 population in 2023 to 12.9 per 100,000 (Figure 2). Nationally, the rate of new laboratory reports of HCV among residents of England rose from 26.6 per 100,000 in 2023 to 28.3 per 100,000 in 2024. The long-term trend of the rate of new laboratory reports of HCV from 2015 to 2024 shows a decline in the East of England, while the national long-term trend has increased post-COVID-19 pandemic.

Table 1. Number and rate per 100,000 population of new laboratory reports of hepatitis C by 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.

In 2024, the East of England had the lowest rate of new laboratory reports of HCV among residents of any region with 12.9 per 100,000 population (Table 1). Apart from London (50.1 per 100, 000 population), the region with the highest rate of new laboratory reports of HCV among residents was the North West, with 35.8 per 100,000 population.

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

Area		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Bedford	Count	50	82	67	74	46	14	9	8	20	9
Bedford	Rate	29.4	47.2	38.2	41.5	25.5	7.7	4.8	4.3	10.4	4.6
Cambridgeshire	Count	212	213	164	105	141	187	286	196	218	161
Cambridgeshire	Rate	32.6	32.4	24.8	15.8	21.1	27.9	42.0	28.4	31.1	22.7
Central Bedfordshire	Count	6	2	22	9	16	4	6	3	4	5
Central Bedfordshire	Rate	2.2	0.7	7.9	3.2	5.6	1.4	2.0	1.0	1.3	1.6
Essex	Count	86	132	131	179	118	72	88	75	78	86
Essex	Rate	5.9	9.0	8.9	12.1	7.9	4.8	5.8	4.9	5.1	5.5
Hertfordshire	Count	293	261	136	107	135	127	184	152	113	87
Hertfordshire	Rate	25.1	22.1	11.5	9.0	11.3	10.6	15.3	12.6	9.3	7.0
Luton	Count	22	51	39	67	57	45	61	68	11	9
Luton	Rate	10.1	23.1	17.7	30.2	25.5	20.1	27.1	29.9	4.7	3.8
Milton Keynes	Count	125	152	111	71	85	31	36	15	57	131
Milton Keynes	Rate	46.3	55.4	40.1	25.5	30.2	10.9	12.5	5.1	19.0	42.8
Norfolk	Count	10	19	156	139	184	122	185	275	73	112
Norfolk	Rate	1.1	2.1	17.4	15.4	20.3	13.4	20.1	29.7	7.8	11.9
Peterborough	Count	188	131	141	129	118	57	83	129	88	107
Peterborough	Rate	93.9	63.9	67.7	61.1	55.4	26.7	38.3	59.2	39.8	47.8
Southend-on-Sea	Count	33	113	39	26	73	53	105	33	23	31
Southend-on-Sea	Rate	18.4	62.6	21.5	14.3	40.1	29.2	58.1	18.3	12.6	16.7
Suffolk	Count	57	98	95	94	87	49	35	28	108	167
Suffolk	Rate	7.7	13.1	12.6	12.4	11.5	6.5	4.6	3.6	13.9	21.2
Thurrock	Count	11	25	18	19	12	7	12	15	14	18
Thurrock	Rate	6.6	14.8	10.5	11.0	6.9	4.0	6.8	8.5	7.8	9.9
No UTLA data available	Count	12	12	12	20	0	5	2	0	8	6
No UTLA data available	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. UTLA data was available for 99% of cases where region data was available.

In 2024, the UTLA in the East of England with the lowest rate of new laboratory reports of HCV, among residents, was Central Bedfordshire with 1.6 per 100,000 population (Table 2). Whilst the UTLA with the highest rate of new laboratory reports of HCV, among residents, was Peterborough with 47.8 per 100,000.

The only UTLAs in the East of England that exceeded the national rate of 28.3 per 100,000, were Milton Keynes and Peterborough UTLAs, with 42.8 and 47.8 per 100,000, respectively.

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

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

In 2024, among every age group of residents in the East of England, the number of new laboratory reports of hepatitis C was higher among males than females (Figure 3).

Among male residents of the East of England the number of new laboratory reports of hepatitis C was highest in the 35 to 44 age group with 103, the age group with the lowest was the 1 to 24 age group with 9.

Among female residents of the East of England the number of new laboratory reports of hepatitis C was highest in the 45 to 54 age group with a total of 52, the age group with the lowest was the 1 to 24 age group with 7.

Figure 4. Ethnicity distribution of new laboratory reports of hepatitis C, residents of East of England 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 (37% 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.

In 2024, among new laboratory reports of HCV diagnoses in residents of the East of England, the ethnicity reported was highest for the ‘White British’ ethnicity group at 62.1%, followed by ‘Any other White background’ at 21.5%, ‘Asian or Asian British’ at 8.9%, ‘Any other’ at 2.8%, ‘Black or Black British’ at 2.6%, and ‘Any Mixed background’ at 2.1% (Figure 4). There is a slight increase for the ‘Asian or Asian British’ group from 7.2% in 2023, and a decrease for the ‘White British’ group from 64.0% in 2023. Interpretation should be made with caution as 37% of laboratory reports had no ethnicity recorded.

HCV testing in the wider population

Figure 5. Number of individuals tested for anti-HCV by year and percentage positive in sentinel laboratories in East of England 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. In the East of England, there are 8 ED sites included in the second phase of the BBV opt-out programme but roll-out was started in March 2025 so data for this period will not have been included yet in this report.

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

In 2024, the number of individuals tested for anti-HCV in sentinel laboratories in the East of England rose from 32,001 in 2023, to 42,027 (Figure 5). The proportion of individuals tested for anti-HCV in sentinel laboratories in the East of England that tested positive fell from 5.0% in 2023 to 2.5%. The increase predates the roll-out of opt-out testing in emergency departments in March 2025, but can be attributed to the region’s continued efforts to increase testing across multiple initiatives in primary, secondary and outreach care.

Figure 6. Number of individuals tested for anti-HCV by year and percentage positive, through GP surgeries, in sentinel laboratories in East of England 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.

The number of individuals tested for anti-HCV, through GP surgeries, in sentinel laboratories in the East of England rose from 5,371 in 2023 to 6,199 in 2024 (Figure 6). The percentage of individuals who tested positive for anti-HCV through GP surgeries, in sentinel laboratories in the East of England UKHSA region remained fairly stable (0.7% in 2023, 0.8% in 2024). There are a number of initiatives in the East of England region that will have contributed to the increase in testing in GP surgeries in 2024, including ‘GP Champion’; the implementation of case-finding HCV through the use of the Primary Care Search Tool across individual GP surgeries; case finding letters sent to GPs to alert them of individuals with an HCV positive result held in the UKHSA surveillance system for whom no evidence of treatment was available; and the introduction of the Cancer Alliance Earlier Detection of Liver Disease navigators, which were placed in hubs supporting homeless people to improve testing and treatment uptake.

Figure 7. Number of individuals tested for anti-HCV by year and percentage positive, through sexual health services, in sentinel laboratories in East of England 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.

In 2024, the number of individuals tested for anti-HCV, through sexual health services, in sentinel laboratories in the East of England rose from 161 in 2023 to 208 (Figure 7). The percentage of individuals who tested positive for anti-HCV, through sexual health services, in sentinel laboratories in The East of England stayed unchanged from 2023 at 0%.

Figure 8. Number of individuals tested for anti-HCV by year and percentage positive, through drug services, in sentinel laboratories in East of England 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.

In 2024, the number of individuals tested for anti-HCV, through drug services, in sentinel laboratories in the East of England fell from 7,173 in 2023 to 6,883 (Figure 8). The decline in testing seen in 2024 may reflect a combination of factors, including saturation of testing within established services, changes in service engagement, and modifications to testing pathways. For example, increasing use of point-of-care tests or changes in laboratory providers may reduce the number of anti-HCV tests recorded through sentinel laboratory surveillance, even where overall testing activity remains stable. This testing remains an important source of case identification.

The percentage of individuals who tested positive for anti-HCV, through drug services, in sentinel laboratories in the East of England fell from 18.5% to 11.5% in 2024.

Figure 9. Number of individuals tested for anti-HCV by year and percentage positive, through emergency departments, in sentinel laboratories in East of England 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. In the East of England, 8 ED sites were included in the second phase, but the BBV opt-out testing roll-out did not start until March 2025.

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

In 2024 the number of individuals tested for anti-HCV, through emergency departments, in sentinel laboratories in East of England rose from 1,654 in 2023 to 2,972 (Figure 9).

The proportion of individuals who tested positive for anti-HCV, through emergency departments in sentinel laboratories in the East of England, remained stable between 2023 and 2024 at 0.7%.

The increase in testing in ED sites in 2024 is surprising as it pre-dates the roll-out of BBV opt-out testing in 8 ED sites in East of England, which did not start until March 2025, and of 4 additional sites in March 2026. It is not clear what caused the increase in testing in ED sites in 2024, but it is plausible the upcoming implementation of the opt-out testing raised staff awareness leading to increased targeted testing prior to the BBV opt-out intervention. This increased targeted testing would explain why the proportion tested positive for anti-HCV has remained stable, and has not dropped which you would expect once BBV opt-out testing is fully implemented.

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 from 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.

The percentage positivity for anti-HCV in sentinel laboratories 2020 to 2024, across recorded ‘setting or reason for test’ was highest for Drug services with 18.2% (4,997 of the 27,464 tested), then prison services with 4.2% (208 of the 5,007 tested), and community outreach with 3.0% (89 of the 3,012 tested) (Figure 10). All other settings or reasons for test categories reported a percentage positivity below 2% of tested cases.

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.

ODN boundaries do not align with UKHSA regional boundaries. The Eastern ODN covers East of England, except for Milton Keynes, West Essex and Hertfordshire UTLAs. Hertfordshire and West Essex fall in the North Central London ODN and Milton Keynes in the Thames Valley ODN.

The operational delivery network (ODN) with the highest percentage of individuals testing anti-HCV positive, among those tested in sentinel laboratories from 2020 to 2024, was South Yorkshire with 30.2% (Figure 11). The Eastern Hepatitis Network was ranked 8th of all ODNs at 4.4%. The ODN with the lowest percentage was West London with 0.5%.

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

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

In 2024, the proportion of individuals testing positive for HCV RNA in sentinel laboratories in East of England, fell from 21.0% (4,557 individuals tested) in 2023 to 16.7% (4,841 individuals tested) in 2024, continuing a long-term trend observed since 2016 (Figure 12), showing the impact of coordinated elimination efforts in the region.

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.

ODN boundaries do not align with UKHSA regional boundaries. The Eastern ODN covers East of England, except for Milton Keynes, West Essex and Hertfordshire UTLAs. Hertfordshire and West Essex fall in the North Central London ODN and Milton Keynes in the Thames Valley ODN.

The ODN with the highest percentage of individuals testing HCV RNA positive among those tested in sentinel laboratories, 2020 to 2024, was South-West Peninsula at 39.5%. Of the 22 ODNs, the Eastern Hepatitis Network had the 11th highest proportion positive of individuals tested for HCV RNA in sentinel laboratories, 2020 to 2024 at 22.4% (Figure 13).

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), East of England and England, 2015 to 2024

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

Note 20: during 2020 and 2021, recruitment to the Unlinked Anonymous Monitoring (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.

The percentage of people who inject drugs (PWID) with evidence of ever being infected with HCV (anti-HCV) in the East of England fell slightly from 46.0% in 2023 to 44.0% in 2024 (Figure 14). While nationally, the percentage of PWID with evidence of ever being infected with HCV (anti-HCV) declined only very slightly (52.6% in 2023 to 51.9% in 2024).

Figure 15. Percentage of Unlinked Anonymous Monitoring (UAM) Survey participants ever infected with HCV who have chronic HCV infection, East of England 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.

In 2024, the percentage of UAM survey participants ever infected with HCV who have chronic HCV infection in the East of England fell from 8.1% in 2023, to 5.6% in 2024 (Figure 15). Nationally, the percentage fell from 13.8% in 2023 to 9.9% in 2024.

Figure 16. Percentage of Unlinked Anonymous Monitoring (UAM) Survey participants who self-reported being recently (current or previous year) tested for HCV, East of England 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.

In 2024, the percentage of PWID who self-reported being recently (current or previous year) tested for HCV in the East of England fell from 48.9% in 2023, to 42.1% in 2024 (Figure 16). Nationally, the percentage of PWID who self-reported being recently (current or previous year) tested for HCV rose from 50.0% in 2023 to 52.6% in 2024.

Hepatitis C treatment pathway

Figure 17. Treatment pathway in East of England, 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 23: 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 24: 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 17a. Treatment pathway in East of England, 2015 to 2024 (Sankey Chart)

Abbreviations:
PII = person identifiable information (recorded NHS number or name, and date of birth)
TD = treatment database
SVR = sustained virological response

Between 2015 and 2024, the HCV treatment pathway in the East of England saw:

Between 2015 and 2024, the HCV treatment pathway in the East of England saw:

Among 9,401 individuals with chronic hepatitis C, of which 6,751 had a recorded NHS number or name, and date of birth.

• 87.0% of individuals with chronic hepatitis C were linked with the treatment database
• 96.5% of individuals linked with the treatment database started treatment (post RNA positive)
• 84.0% of individuals with chronic hepatitis C, started treatment (post RNA positive), meeting the WHO elimination target for treatment coverage (≥80%)
• 94.5% of individuals who started treatment (post RNA positive) reported an outcome
• 93.6% of individuals who started treatment (post RNA positive) reported an outcome achieved sustained virological response (SVR)
• 88.5% of individuals who started treatment (post RNA positive) achieved SVR

Treatment pathway by operational delivery network (ODN)

1) Eastern Hepatitis Network ODN

Figure 18. Treatment pathway by operational delivery network (ODN) in Eastern Hepatitis Network 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 25: 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 26: 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.

ODN boundaries do not align with UKHSA regional boundaries. The Eastern ODN covers East of England, except for Milton Keynes, West Essex and Hertfordshire UTLAs. Hertfordshire and West Essex fall in the North Central London ODN and Milton Keynes in the Thames Valley ODN, with data captured in the Hepatitis C in the South East Region and Hepatitis C in London reports.

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

Between 2015 and 2024, the HCV treatment pathway run by the Eastern Hepatitis Network ODN in the East of England saw 8,123 individuals with chronic hepatitis C, of which 5,873 had a recorded NHS number or name, and date of birth. Of these:

• 87.5% of individuals with chronic hepatitis C, were linked with the treatment database
• 96.3% of individuals linked with treatment database started treatment (post RNA positive)
• 84.3% of individuals with chronic hepatitis C started treatment (post RNA positive) meeting the WHO elimination target for treatment coverage (≥80%)
• 94.6% of individuals who started treatment (post RNA positive) reported an outcome
• 93.5% of individuals who started treatment (post RNA positive) reported an outcome, achieved sustained virological response (SVR)
• 88.5% of individuals who started treatment (post RNA positive) achieved SVR

Reinfections in individuals initiating treatment

For people who initiated treatment between 2015 and 2024 in East of England, the reinfection rate was 5.4 per 100 person-years (95% CI 4.7 to 6.1), 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 9.2 per 100 person-years (95% CI 8.0 to 10.6), which was slightly higher than the England estimate. For individuals whose last injection was more than 3 years earlier, the rate was 4.1 per 100 person-years (95% CI 3.4 to 4.9), again slightly higher than the England estimate. Among people with any history of imprisonment before starting treatment, the reinfection rate was 9.0 per 100 person-years (95% CI 7.3 to 11.0), which was slightly lower than the England estimate.

Monitoring HCV-related morbidity

Hospital admissions from HCV

Figure 19. Number of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), East of England 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 27: 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 28: 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 29: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 30: data based on HES as of December 2025.

Figure 20. Rate per 100,000 of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), East of England 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 31: 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 32: 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 33: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 34: data based on HES as of December 2025.

Figure 19 shows the number of first hospital admissions for hepatitis C-related end-stage liver disease and/or hepatocellular carcinoma, which provide a measure of severe disease burden.

The estimated number of first hospital admissions for hepatitis C-related ESLD and/or hepatocellular carcinoma (HCC), in the East of England rose from between 83 and 96 (lower-upper estimate) in 2023, to between 96 and 116 in 2024 (Figure 19). The number of first hospital admissions for hepatitis C-related ESLD and/or HCC, in England fell from between 1226 and 1458 in 2023 to between 1165 and 1409 in 2024.

Figure 20 shows rates of first hospital admissions in the East of England and England, with the East of England rates being consistently lower than rates for England. In the East of England, the estimated rate of first hospital admissions for hepatitis C-related end-stage liver disease and/or hepatocellular carcinoma rose from 1.2-1.4 per 100,000 (lower/upper estimate) to 1.3-1.6 per 100,000 (Figure 20). In England the rate of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) fell from 2.1-2.5 per 100,000 to 2.0-2.4 per 100,000 (lower/upper estimate).

HCV-related mortality

Figure 21. Number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), East of England, 2005 to 2024

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

The number of deaths attributable to hepatitis C-related liver disease has fluctuated over time. Due to new methodologies being used to derive better estimates for mortality data there are 2 estimates giving the 2 trend lines in the figure above, a lower and upper estimate. The lower estimate 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.

For the East of England, the estimated number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) rose from 17-42 (lower/upper estimates) in 2023 to 23-53 in 2024 (Figure 21).

Monitoring mortality trends remains an important measure for assessing progress towards reducing the severe consequences of chronic hepatitis C infection.

Figure 22. 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.

The mortality rate for hepatitis C-related ESLD and/or HCC in the East of England from 2020 to 2024, was 0.9 per 100,000 population (Figure 22). This places the East of England as the 2nd lowest of the 9 regions. The UKHSA region with the lowest mortality rate for hepatitis C-related ESLD and/or HCC, from 2020 to 2024, was the North-East, with 0.8 per 100,000 population. The UKHSA region with the highest mortality rate for hepatitis C-related ESLD and/or HCC, from 2020 to 2024, was London, with 1.9 per 100,000 population.

Prevention of infection by harm reduction

Figure 23. Reported level of direct sharing of needles/syringes among people who inject drugs (PWID), in the preceding 4 weeks, East of England and England, 2015 to 2024

Data sources: UAM Survey. For more information, see Information on data sources.

Note 35: 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. Year-to-year variation may reflect changes in participant characteristics, service engagement or sampling variability, particularly at regional level.

Figure 24. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID), in the preceding 4 weeks, East of England and England, 2015 to 2024

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

Note 36: 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. Year-to-year variation may reflect changes in participant characteristics, service engagement or sampling variability, particularly at regional level.

Figure 23 shows self-reported levels of direct sharing of needles or syringes among PWID, and figure 24 shows levels of both direct and indirect sharing of injecting equipment among PWID for the East of England and England. Sharing of injecting equipment remains a key risk factor for hepatitis C transmission, and reducing these behaviours over time continues to be a challenge among this risk group.

In 2024, the percentage of self-reported direct sharing of needles or syringes among people who inject drugs (PWID), in the preceding 4 weeks, in the East of England, fell from 23.5% in 2023 to 13.8% in 2024 (Figure 23). The reported level of direct sharing of needles/syringes among PWID, in the preceding 4 weeks in England remained unchanged between 2023 and 2024 (25.0% and 24.8%).

The percentage of reported direct and indirect sharing of injecting equipment among PWID, in the preceding 4 weeks, in the East of England, fell from 50.0% in 2023 to 38.7% in 2024 (Figure 24). The percentage of reported direct and indirect sharing of injecting equipment among PWID, in the preceding 4 weeks, in England changed very little from 43.9% in 2023 to 44.4% in 2024.

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 local authority and UKHSA region of registered general practice; where both patient postcode and registered general practice are unknown data is assigned to 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 de-duplicate.

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, de-duplication, 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 towards 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, 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 EFEU@ukhsa.gov.uk

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