Research and analysis

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

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

Summary

Key findings for hepatitis C testing:

• there were 888 new laboratory reports of hepatitis C in residents of the North East UKHSA region, representing a rate of 32.2 reports per 100,000 population in 2024
• the number of new laboratory reports has increased by 14.3% since 2023 and increased by 311.1% over the past 10 years
• in 2024, the number of positive laboratory reports by upper tier local authority of residence ranged from 8 in Darlington to 272 in Newcastle upon Tyne. Rates were highest in Newcastle upon Tyne, at 84.8, and lowest in Darlington, at 7.1
• in 2024, the number of laboratory reports in males was 625 (70.4%) and in females 247 (27.8%). Sex was unknown in 1.8% of cases
• in 2024, the highest number of laboratory reports was in males aged 35 to 44 (243 laboratory reports) and females aged 35 to 44 (89 laboratory reports)
• 25,458 individuals were tested for anti-HCV in sentinel laboratories in North East UKHSA region in 2024, of which 2.8% tested positive. The proportion positive was lower for tests referred from general practitioner (GP) surgeries (0.4%) and higher for tests from drug services (17.4%)

Key finding for hepatitis C treatment pathway:

• of 4,646 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), 4,498 (96.8%) started treatment within 90 days and 3,876 (86.2%) achieved a sustained viral response (SVR), in the North East UKHSA region between 2015 and 2024

Key findings for HCV-related morbidity and mortality:

• estimated hospital admissions for individuals with hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) in the North East UKHSA region increased in 2024, ranging from 40 to 49 admissions compared with 33 to 48 in 2023
• estimated deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) in the North East UKHSA region were between 9 and 17 in 2024, compared with an estimated 5 to 20 deaths in 2023

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

The following tables and charts are derived from laboratory surveillance data. Laboratory reports reflect testing and reporting activity as well as underlying infection patterns, and trends may be influenced by changes in testing, screening and service provision. As these factors vary over time and between geographical areas, comparisons should be made with caution. For hepatitis C, new laboratory reports represent diagnosed infections rather than new infections and should not be interpreted as a direct measure of incidence.

New laboratory-confirmed diagnoses of HCV

Figure 1. Number of new laboratory reports of hepatitis C, residents of the North East 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.

There were 888 new laboratory reports of hepatitis C in the North East in 2024, an increase of 14.3% from 777 in 2023. Reports have more than doubled since 2017 (390 laboratory reports), although numbers have fallen from the peak of 1,071 in 2022.

Figure 2. Rate per 100,000 population of new laboratory reports of hepatitis C, residents of the North East 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.

The rate of new laboratory reports in the North East increased from 28.5 per 100,000 in 2023 to 32.2 in 2024. This was higher than the England rate of 28.3 per 100,000 in 2024. The regional rate rose from 8.3 per 100,000 in 2015 and exceeded the England rate from 2019 onwards. The ‘opt out’ BBV testing programme may have contributed to a rise in new diagnoses in England. No hospitals in the North East have been included in this programme to date; however, James Cook Hospital in Middlesbrough began a separately funded opt-out BBV testing programme, including HCV, in 2024.

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.

In 2024, the North East recorded 888 laboratory reports, a rate of 32.2 per 100,000 population. This was the third-highest regional rate after London (50.1) and the North West (35.8) and was above the England rate of 28.3 per 100,000. The North East rate increased by 13.0% between 2023 and 2024, compared with a 6.4% increase nationally. Regional comparisons should consider differences in testing coverage, targeted case-finding activity and the completeness of geographic information.

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
County Durham	Count	38	35	48	77	224	133	132	158	127	194
County Durham	Rate	7.4	6.8	9.3	14.9	43.2	25.6	25.3	29.9	23.8	36.1
Darlington	Count	9	16	11	11	11	16	37	16	16	8
Darlington	Rate	8.5	15.1	10.3	10.3	10.3	15.0	34.2	14.6	14.4	7.1
Gateshead	Count	20	55	90	121	165	119	158	161	39	55
Gateshead	Rate	9.9	27.3	44.9	60.5	83.2	60.3	80.5	81.1	19.4	27.1
Hartlepool	Count	6	11	17	17	5	20	22	29	29	18
Hartlepool	Rate	6.5	11.9	18.4	18.4	5.4	21.7	23.8	30.8	30.2	18.3
Middlesbrough	Count	33	26	35	103	74	41	39	56	48	75
Middlesbrough	Rate	23.6	18.5	24.8	73.0	52.1	28.8	27.1	37.5	31.2	48.0
Newcastle upon Tyne	Count	2	11	81	157	194	140	166	240	261	272
Newcastle upon Tyne	Rate	0.7	3.8	27.8	53.2	65.3	46.9	55.6	78.7	83.2	84.8
North Tyneside	Count	0	2	14	28	43	20	37	43	37	39
North Tyneside	Rate	0.0	1.0	6.8	13.6	20.7	9.6	17.7	20.4	17.4	18.1
Northumberland	Count	4	2	22	41	100	59	60	74	82	87
Northumberland	Rate	1.3	0.6	7.0	13.0	31.4	18.5	18.7	22.8	25.0	26.3
Redcar and Cleveland	Count	8	7	8	20	6	6	15	29	38	43
Redcar and Cleveland	Rate	5.9	5.2	5.9	14.7	4.4	4.4	11.0	21.1	27.5	30.9
South Tyneside	Count	35	12	16	21	24	17	26	26	17	20
South Tyneside	Rate	23.8	8.1	10.8	14.2	16.2	11.5	17.6	17.5	11.3	13.2
Stockton-on-Tees	Count	8	9	19	106	85	90	169	172	50	37
Stockton-on-Tees	Rate	4.1	4.6	9.6	53.7	43.2	45.8	85.8	85.7	24.5	17.9
Sunderland	Count	53	41	29	48	36	39	42	67	33	39
Sunderland	Rate	19.2	14.9	10.6	17.5	13.1	14.3	15.3	24.1	11.6	13.5
No UTLA data available	Count	0	1	0	0	0	0	0	0	0	1
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 100% of cases where region data was available.

There was substantial variation between upper tier local authorities in 2024, with counts ranging from 8 in Darlington to 272 in Newcastle upon Tyne. Newcastle upon Tyne had the highest rate at 84.8 per 100,000 population, followed by Middlesbrough at 48.0 and County Durham at 36.1, while Darlington had the lowest rate at 7.1 per 100,000 population. County Durham and Middlesbrough recorded marked increases from 2023, whereas Darlington, Hartlepool and Stockton-on-Tees recorded declines. Local differences may reflect testing activity rather than incidence alone.

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

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

Males accounted for substantially more laboratory reports than females in every age group in 2024, except among those aged 65 years and over where numbers were similar. The greatest number of reports was among people aged 35 to 44 years, including 243 males and 89 females. Males aged 45 to 54 years and 25 to 34 years also accounted for large numbers of reports, at 152 and 123, respectively.

Figure 4. Ethnicity distribution of new laboratory reports of hepatitis C, residents of the North East 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. A total of 27% 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.

White British people accounted for most reports with known ethnicity throughout the period and represented 90.6% in 2024. Between 2015 and 2024 the proportion was broadly stable, ranging from 86.4% (2016) to 94.0% (2020). Interpretation is limited because ethnicity was not recorded for 27.0% of reports.

HCV testing in the wider population

Figure 5. Number of individuals tested for anti-HCV by year and percentage positive in sentinel laboratories in the North East 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.

A total of 25,458 individuals were tested for anti-HCV in sentinel laboratories in 2024, similar to the number tested in 2023 (25,509 individuals tested). The number of individuals tested by sentinel laboratories has increased steadily over the past decade, rising from 14,634 in 2015. The proportion positive fell from 3.7% in 2023 to 2.8% in 2024.

Numbers tested and positivity rates according to service type (GP, sexual health services and/or drug services and EDs) are presented in Figures 6 to 9. Positivity among tests referred through drug services remained substantially higher than that seen in other testing settings (17.4%), reflecting the targeted testing of populations at increased risk of HCV infection. Positivity among GP-referred and emergency department referrals was 0.4% and 0.6%, respectively. Although no tests from sexual health services were positive, only 54 tests from these services were processed in sentinel laboratories.

Trends should be interpreted with caution within the different settings as they may be due to changes in testing activities and only a subset of tests being sent to sentinel laboratories.

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

GP-referred anti-HCV testing has been increasing since 2015 (n = 1,392) with 3,029 individuals tested in 2024, an increase of 10.3% from 2023. The proportion positive was 0.4%, unchanged from 2023 and substantially below 1.2% in 2015.

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

Only 54 individuals were recorded as tested through sexual health services in 2024, compared with 1,613 in 2023, and none tested positive. The marked reduction in sexual health service testing in 2024 reflects changes in provider that resulted in samples no longer being sent to the North East sentinel surveillance laboratory.

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

Drug services tested 2,333 individuals for anti-HCV in 2024, down 6.7% from 2,501 in 2023. The proportion testing positive fell from 23.4% in 2023 to 17.4% in 2024, continuing the downward trend observed since the peak in early 2021.

Figure 9. Number of individuals tested for anti-HCV by year and percentage positive, through emergency departments, in sentinel laboratories in the North East 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.

Emergency department anti-HCV testing increased by 19.5% from 292 individuals in 2023 to 349 in 2024. Positivity fell from 1.0% to 0.6%, although confidence intervals were wide.

From 2022 to 2024, the opt-out ED BBV testing programme across England was scaled-up, leading to increased numbers of tests being conducted in sentinel surveillance sites nationally. Although there were no nationally funded ED opt-out programmes in the North East over this period, one hospital in the region began implementing opt-out ED BBV testing in 2024. However, this testing is not done in a sentinel laboratory and will not be captured in these figures.

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.

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.

Drug services had the highest anti-HCV positivity between 2020 and 2024 (22.2%), with 2,925 positive individuals. Community outreach had the second-highest positivity rate (10.0%), with 41 positive individuals, although less than 1% of individuals were tested through this route. Prison services identified 895 positive individuals with a positivity rate of 3.8%. Hospitals had a positivity rate of 1.3%, with 694 positive individuals and accounted for the largest number of individuals tested (52,344 tested). Positivity was less than 1% in GP, emergency department, sexual health testing, paediatrics, occupational health and FMTC (fertility/mother-to-child), although these settings collectively reached large numbers of people (30,149 tested).

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 North East 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.

The North East and North Cumbria Operational Delivery Network (ODN) tested 120,701 individuals for anti-HCV between 2020 and 2024 and identified 5,207 positive individuals. Positivity was 4.3%, placing the ODN in the middle of the national distribution. ODN comparisons should not be used as direct comparisons of population prevalence between areas as laboratory coverage and referral sources differ.

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

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

The proportion of people who were positive for HCV RNA in sentinel laboratory testing declined from 44.8% in 2015 to 24.3% in 2024, while the number tested increased from 1,797 in 2015 to 4,610 in 2024.

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

The North East and North Cumbria ODN recorded 6,757 HCV RNA-positive individuals among 20,537 tested between 2020 and 2024 (32.9% positivity). This is the fourth-highest positivity over all ODNs.

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), in the North East UKHSA region and England, 2015 to 2024

Data source: 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, 58.7% of UAM Survey participants in the North East had evidence of ever being infected with HCV, compared with 51.9% across England. The regional proportion increased from 52.5% in 2023 but remains below the peak of 71.8% in 2020 to 2021. This measure represents cumulative exposure and remains positive after successful treatment, so it does not indicate current infection. Regional annual estimates can fluctuate because the survey recruits through participating services.

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

Data sources: 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.

Following a peak of 67.4% in 2018, the proportion of UAM Survey participants with chronic HCV in the North East declined to 22.0% in 2024. Despite this reduction, the proportion remained more than twice the England estimate (9.9%). The reduction is consistent with the impact of expanded testing and direct-acting antiviral treatment among people who inject drugs.

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

Data sources: 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.

In 2024, 59.2% of UAM Survey participants in the North East reported having had an HCV test in the current or previous year. This was higher than the England estimate of 52.6% and an increase of 10.4 percentage points from 2023. Recent testing in the region has increased overall over the past 10 years from a low of 34.9% in 2016.

Hepatitis C treatment pathway

Figure 17. Treatment pathway in the North East 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.

Between 2015 and 2024, 87.0% of individuals with chronic hepatitis C were linked to treatment, of whom 96.8% initiated treatment. Overall, 84.2% of individuals with chronic hepatitis C started treatment, exceeding the WHO elimination target for treatment coverage (≥80%). Among those who started treatment, 93.2% had a recorded outcome and 92.5% of these achieved sustained virological response (SVR), equivalent to 86.2% of those who started treatment.

Treatment pathway by operational delivery network (ODN)

1) North East and North Cumbria ODN

Figure 18. Treatment pathway by operational delivery network (ODN) in the North East and North Cumbria 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.

See notes 24 and 25

Note 26: ODN boundaries do not fully align with UKHSA regional boundaries, so not all North East residents may be captured in this chart. 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 residents of this region may be in ODNs falling in other regions.

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, 86.7% of individuals with chronic hepatitis C in the North East and North Cumbria ODN were linked to treatment, of whom 96.8% initiated treatment. Overall, 84.0% of individuals with chronic hepatitis C started treatment, exceeding the WHO elimination target for treatment coverage (≥80%). Among those who started treatment, 93.1% had a recorded outcome and 92.6% of these achieved SVR, equivalent to 86.2% of those who started treatment.

Reinfections in individuals initiating treatment

For people who initiated treatment between 2015 and 2024 in the North East, the reinfection rate was 16.4 per 100 person-years (95% confidence interval (CI) 15.5 to 17.4), which was higher 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 three years prior to treatment initiation, the reinfection rate was 17.7 per 100 person-years (95% CI 16.6 to 18.8), again higher than the England estimate. For individuals whose last injection was more than three years earlier, the rate was 11.2 per 100 person-years (95% CI 8.6 to 14.2), again higher than the England estimate. Among people with any history of imprisonment before starting treatment, the reinfection rate was 18.2 per 100 person-years (95% CI 16.9 to 19.5), also higher 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), in the North East 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 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 deduplication 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.

The 2024 range estimates for first hospital admissions for HCV-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) in the North East are broadly similar to levels seen in previous years. The lower estimate of first hospital admissions increased from 33 in 2023 to 40 in 2024. The upper estimate increased slightly from 48 to 49. National estimates continued to decline between 2023 and 2024, from 1,226 to 1,165 for the lower estimate and from 1,458 to 1,409 for the upper.

Figure 20. Rate per 100,000 of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), in the North East 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 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 deduplication 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.

The 2024 range estimates for rate per 100,000 population of first hospital admissions for HCV-related ESLD and/or HCC in the North East are broadly similar to levels seen in previous years. The lower estimate of first hospital admissions increased from 1.2 per 100,000 in 2023 to 1.5 in 2024. The upper estimate remained at 1.8 per 100,000.

HCV-related mortality

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

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

There were 9 deaths in the lower estimate for HCV-related ESLD and/or HCC in the North East in 2024, up from 5 in 2023. The upper estimate fell from 20 to 17 deaths, resulting in a narrower estimated range compared to 2023. Mortality has fluctuated over the period, with the highest upper estimate of 26 deaths recorded in 2022.

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.

Across 2020 to 2024, the HCV-related ESLD and/or HCC mortality rate in the North East was 0.8 per 100,000 population (CI 0.7 to 0.9). This was the lowest regional rate, with the highest regional rates in the North West (1.9, CI 1.8 to 2.0) and London (1.9, CI 1.9 to 2.0). Regional differences may reflect historic HCV prevalence, population risk profiles and ascertainment and should be considered alongside uncertainty in attributing deaths to HCV.

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, in the North East UKHSA region 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.

In 2024, 29.2% of UAM Survey participants in the North East reported direct sharing of needles or syringes in the preceding four weeks. This was higher than the England estimate of 24.8% and a slight increase from 27.0% in 2023.

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

Data sources: 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.

In 2024, 52.2% of UAM Survey participants in the North East reported direct or indirect sharing of injecting equipment in the preceding four weeks. This was higher than the England estimate of 44.4% and increased from 48.1% in 2023.

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 deduplicate.

Laboratory reports for children under one 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, while SGSS collects national-level data, SSBBV collects data from a subset of laboratories. Currently, 35 laboratories report to SSBBV, with an estimated testing coverage of 45% 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 deduplicate. Data is deduplicated 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 an 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 a) persons initiating treatment being added to the NHSE Blueteq System or NHSE Hepatitis C Patient Registry and Treatment Outcome System, b) sufficient identifiers being available to link between the treatment and SSBBV databases, and c) 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 after 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 an 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 a 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 deduplicate. Data is deduplicated 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 is 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 multidisciplinary 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.northeast@ukhsa.gov.uk

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