Research and analysis

Hepatitis C in the North West 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 North West 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:

• there were 2,767 new laboratory reports of hepatitis C in residents of the North West UKHSA region, representing a rate of 35.8 reports per 100,000 population in 2024
• the number of new laboratory reports has decreased by 2.1% since 2023 and decreased by 5.7% over the past 10 years
• in 2024, the number of positive laboratory reports by upper tier local authority of residence ranged from 13 in Halton to 781 in Manchester. Rates were highest in Manchester at 132.4 per 100,000 and lowest in Stockport with 4.9 per 100,000
• in 2024, the number of laboratory reports in males was 1,555 (56.2%) and in females was 704 (25.4%). Sex was unknown in 18.4% of cases
• in 2024, the highest number of laboratory reports was in males aged 45 to 54 and females aged 35 to 44
• there were 210,803 individuals tested for anti-HCV in sentinel laboratories in the North West UKHSA region in 2024, of which 2.1% tested positive. The proportion positive was lower for tests referred from general practitioner (GP) surgeries and sexual health services, and higher for tests from drug services; the total number of tests conducted has likely increased since 2022 as a result of a new ‘opt-out’ bloodborne virus testing programme at selected emergency departments

Key finding for hepatitis C treatment pathway:

• of 11,682 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), 11,501 started treatment within 90 days and 10,127 achieved a sustained viral response (SVR), in North West UKHSA region between 2015 and 2024

Key findings for HCV-related morbidity and mortality:

• there were estimated to be between 136 and 177 hospital admissions for individuals with a diagnosis code for hepatitis C-related end-stage liver disease or hepatitis C-related hepatocellular carcinoma in the North West UKHSA region in 2024. This was lower than in 2023 (estimated hospital admissions: 172 to 206)
• there were estimated to be between 24 and 90 registered deaths from hepatitis C–related end‑stage liver disease and/or hepatocellular carcinoma in the North West UKHSA region in 2024. This was lower than in 2023 (estimated deaths: 35 to 97)

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 North West 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.

The figure shows the trend in the number of new laboratory reports of hepatitis C between 2015 and 2024 in North West residents. There were 2,767 new laboratory reports of hepatitis C in 2024. This represented a 2% decrease compared to 2023. The number of reports fluctuated over the 10-year period. There was a decline from 2,935 in 2015 to 2485 in 2017, before increasing to a peak of 3467 in 2018. Numbers declined sharply in 2020 and then recovered to pre-pandemic levels from 2021, remaining relatively stable through to 2024.

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

In 2024, the rate of new hepatitis C laboratory reports in North West residents was 35.8 per 100,000 population, higher than the England rate (28.3).

Between 2015 and 2024 the rate in the North West remained consistently higher than the England rate. The North West rate declined between 2015 and 2017 from 40.9 to 34.2 before peaking at 47.4 in 2018. The rate declined sharply in 2020 before returning to pre-pandemic levels in 2021 (37.5) and remaining relatively stable through to 2024 (35.8).

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 UKHSA region for 253 cases, meaning that the sum of all regional cases may not equal the number of England cases.

In 2024, UKHSA received 2,767 new laboratory reports of hepatitis C in North West residents, which was 16.7% of all reports received in England. There were 35.8 new laboratory reports of hepatitis C per 100,000 population in the North West in 2024, higher than the England rate (28.3 per 100,000) and the second highest regional rate after London (50.1 per 100,000).

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
Blackburn with Darwen	Count	51	75	26	44	74	51	67	73	45	31
Blackburn with Darwen	Rate	33.9	49.5	17.1	28.8	48.0	33.0	43.2	46.7	28.3	19.1
Blackpool	Count	70	20	50	78	80	49	37	56	128	174
Blackpool	Rate	49.4	14.1	35.2	55.0	56.2	34.6	26.2	39.5	89.5	120.7
Bolton	Count	66	38	27	48	70	51	66	73	32	48
Bolton	Rate	23.2	13.2	9.3	16.5	23.7	17.2	22.3	24.3	10.5	15.5
Bury	Count	110	144	128	110	55	60	31	38	28	14
Bury	Rate	58.1	75.6	66.7	57.0	28.4	31.0	16.0	19.5	14.2	7.0
Cheshire East	Count	76	38	36	62	85	46	53	70	39	34
Cheshire East	Rate	20.1	10.0	9.4	16.0	21.8	11.7	13.2	17.2	9.4	8.1
Cheshire West and Chester	Count	56	50	59	99	70	64	56	74	233	352
Cheshire West and Chester	Rate	16.5	14.6	17.1	28.3	19.8	18.0	15.7	20.4	63.5	94.7
Cumberland	Count	40	31	29	88	53	19	75	83	84	84
Cumberland	Rate	14.6	11.3	10.6	32.2	19.4	7.0	27.4	30.1	30.2	29.9
Halton	Count	10	4	17	27	57	32	46	60	10	13
Halton	Rate	7.9	3.2	13.4	21.1	44.4	24.9	35.8	46.4	7.7	9.9
Knowsley	Count	18	6	7	16	17	8	37	30	28	23
Knowsley	Rate	12.2	4.1	4.7	10.7	11.2	5.2	23.9	19.1	17.5	14.1
Lancashire	Count	402	270	155	266	388	233	449	593	302	312
Lancashire	Rate	33.8	22.6	12.9	22.0	31.9	19.0	36.3	47.2	23.7	24.1
Liverpool	Count	39	82	63	111	151	73	237	278	347	245
Liverpool	Rate	8.3	17.2	13.1	23.0	31.2	15.1	48.9	56.3	69.0	48.1
Manchester	Count	1,354	1,285	1,424	1,694	1,120	308	943	527	1,061	781
Manchester	Rate	258.7	240.9	265.2	313.3	205.1	56.3	171.3	92.6	182.5	132.4
Oldham	Count	84	54	73	65	45	15	17	23	80	250
Oldham	Rate	36.1	23.0	30.8	27.1	18.6	6.2	7.0	9.4	32.3	99.4
Rochdale	Count	40	50	43	45	37	22	13	27	49	93
Rochdale	Rate	18.6	23.1	19.7	20.5	16.7	9.9	5.8	11.9	21.2	39.5
Salford	Count	71	68	46	93	122	78	86	89	76	53
Salford	Rate	28.8	27.0	18.0	35.9	46.3	29.3	31.8	31.8	26.5	18.0
Sefton	Count	14	15	10	17	32	14	32	60	39	34
Sefton	Rate	5.1	5.4	3.6	6.1	11.5	5.0	11.4	21.3	13.7	11.9
St. Helens	Count	120	110	78	99	106	82	119	94	27	28
St. Helens	Rate	67.3	61.4	43.3	54.7	58.4	45.0	64.9	50.8	14.4	14.8
Stockport	Count	39	24	14	54	55	33	23	32	18	15
Stockport	Rate	13.5	8.3	4.8	18.5	18.8	11.2	7.8	10.8	6.0	4.9
Tameside	Count	39	28	22	34	58	29	38	50	15	21
Tameside	Rate	17.4	12.4	9.7	14.9	25.2	12.6	16.4	21.4	6.4	8.8
Trafford	Count	26	19	19	59	60	18	26	33	16	21
Trafford	Rate	11.2	8.1	8.1	25.0	25.4	7.6	11.0	13.9	6.7	8.7
Warrington	Count	36	26	7	37	46	31	105	83	22	25
Warrington	Rate	17.2	12.3	3.3	17.5	21.7	14.6	49.7	39.2	10.3	11.6
Westmorland and Furness	Count	26	21	40	51	28	13	23	45	39	23
Westmorland and Furness	Rate	11.6	9.3	17.8	22.6	12.4	5.8	10.1	19.8	17.1	10.0
Wigan	Count	52	68	67	68	72	39	71	72	60	40
Wigan	Rate	16.2	21.2	20.8	21.0	22.1	11.9	21.5	21.5	17.6	11.6
Wirral	Count	92	98	37	135	82	94	130	129	48	38
Wirral	Rate	28.7	30.5	11.5	42.1	25.6	29.4	40.5	40.0	14.7	11.6
No UTLA data available	Count	4	1	8	67	1	0	2	1	0	15
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 UKHSA region for 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.

The table presents the number and rate of new laboratory reports of hepatitis C in North West residents by upper tier local authority of residence (UTLA) between 2015 and 2024. In 2024, Manchester had the highest rate of new laboratory reports (132.4 per 100,000 population), and Stockport had the lowest (4.9 per 100,000). The increase in the number and rate of new laboratory reports of hepatitis C in some UTLAs between 2023 and 2024 is likely to reflect expansion of Emergency Department opt-out testing.

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

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

In 2024, of 2,767 new hepatitis C laboratory reports in North West residents, 1555 were in males (56.2%), 704 were in females (25.4%) and sex was unknown for 508 (18.4%) of reports. The most affected groups were males aged 45 to 54 (471), 35 to 44 (417), 55 to 64 (315).

Figure 4. Ethnicity distribution of new laboratory reports of hepatitis C, residents of North West 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 (39.2% 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.

The distribution of new laboratory reports of hepatitis C by ethnicity remained stable between 2015 and 2024. White British individuals consistently accounted for the majority of diagnoses (70 to 80%). Asian and Asian British individuals represented the second largest group (7 to 13%), followed by people of any other White background (7 to 10%). Black or Black British, Mixed background and Other ethnic groups accounted for a small proportion of diagnoses, generally below 5%. In 2024, the distribution of new laboratory reports by ethnicity remained stable compared to 2023, the highest number of new laboratory reports were in North West residents of White British ethnicity (78.8%), followed by Asian or Asian British ethnicity (8.98%) and any other White background (7.26%).

HCV testing in the wider population

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

The figure shows the number of individuals tested for anti-HCV at sentinel laboratories in the North West between 2015 and 2024, and the proportion of those individuals who were positive. In 2024, 210,803 people were tested and 2.1% of these individuals were positive. It should be noted that sentinel laboratory data include individuals resident outside the North West, which explains why a positivity rate of 2% equates to more positive tests than the number of new hepatitis C laboratory reports in North West residents presented in Figure 1. The number of individuals tested was stable between 2015 and 2019 at between 32,000 and 48,000 tests. The introduction of Emergency Department opt-out testing in 2021, followed by expansion of the programme between 2022 and 2024, resulted in a substantial increase in testing at sentinel sites. While test positivity remained between 2% and 3% from 2015 to 2023, it has declined since 2021 as testing volumes have increased.

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

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

In 2024, 10,476 individuals were tested for anti-HCV through GP surgeries in sentinel laboratories in the North West, of which 0.6% tested positive. Testing through GP surgeries remained relatively stable between 2015 and 2022, with a temporary decline in 2020. Testing then increased markedly between 2022 and 2024. Test positivity declined steadily between 2015 and 2024 from 2.2% to 0.6%.

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

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

There were 13,755 individuals tested for anti-HCV through sexual health services (SHS) in 2024, 0.99% of those individuals tested were positive. Following a decline between 2015 and 2020, testing activity increased notably from 2021 onwards, reaching a peak in 2024. Test positivity remained relatively stable between 2015 and 2024, declining from 1.0% in 2015 to 0.6% in 2021 before returning to 1.0% in 2024.

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

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

The number of individuals tested for anti-HCV through drug services was stable between 2015 and 2018, at between 1,300 and 1,800 individuals tested. Testing then increased steadily from 2018 to a peak of 9,356 in 2023 before declining to 7,999 in 2024. Test positivity remained high but declined overall between 2015 and 2024 from 25.0% to 20.3%, although with year-to-year variation.

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

Testing for anti-HCV through emergency departments remained between approximately 600 and 800 individuals from 2015 through to 2021. The introduction of Emergency Department opt-out testing in 2021, followed by expansion of the programme between 2022 and 2024, resulted in a substantial increase in testing at North West sentinel sites from 1,156 in 2021 to 131,741 in 2024. During the period when testing was low between 2015 and 2021, test positivity remained between 1% and 3%. Since testing has increased, positivity has fallen to around 0.4 to 0.5%.

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

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

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

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

The figure shows the percentage of individuals tested who were positive for anti-HCV by the setting where the test was conducted or the reason for the test. The highest proportion of positive tests were from individuals tested in community outreach (24.4%), although this only represented a small number of individuals tested, followed by drug services (21.4%). Positivity of tests conducted through prison services was 6.8% and for the remaining settings and risk factors was less than 1%.

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. 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 West 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 figure shows the proportion of individuals tested in sentinel laboratories who tested positive for anti-HCV by operational delivery network (ODN). The ODN where the highest proportion of individuals tested positive was South Yorkshire (30.2%) and the lowest was West London (0.48%). Of the ODNs covering the majority of the North West population, the proportion of individuals who tested positive for anti-HCV was highest in Lancashire and South Cumbria (5.7%), followed by Cheshire and Merseyside (2.4%) and then Greater Manchester and Eastern Cheshire (1.7%).

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

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

Individuals who are positive for anti-HCV receive further testing for HCV RNA. HCV RNA indicates active hepatitis C infection. The figure shows the percentage of individuals tested who were positive for HCV RNA in North West sentinel laboratories. The percentage of individuals who tested positive for HCV RNA declined steadily between 2015 and 2024 from 46.3% (3,673 RNA positive individuals of 7,938 tested) to 12.5% (2116 RNA positive individuals of 16,868 tested). This represented a 42.4% reduction in the number of RNA positive individuals detected at sentinel laboratories over the period.

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

Individuals who are positive for anti-HCV, receive further testing for HCV RNA. HCV RNA indicates active hepatitis C infection. The figure shows the proportion of individuals tested for HCV RNA in sentinel laboratories who tested positive, by operational delivery network (ODN). The ODN where the highest proportion of individuals tested positive was South West Peninsula (39.5%) and the lowest was West London (7.5%). Of the ODNs covering the majority of the North West population, the proportion of individuals who tested positive for HCV RNA was highest in Cheshire and Merseyside (21.1%), followed by Lancashire and South Cumbria (20.6%), and then Greater Manchester and Eastern Cheshire (15.4%).

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), North West UKHSA region and England, 2015 to 2024

Data sources: 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.

Among participants in the UAM Survey using services in the North West, the proportion with evidence of ever being infected with HCV (anti-HCV positive) declined from 67.9% in 2015 to 52.0% in 2024, although there was some year-to-year variation in this trend. The proportion with evidence of ever being infected with HCV in the North West was consistently higher than in England up to 2022, but similar to the proportion in England overall in 2023 and 2024 (51% to 52%).

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

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

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

The prevalence of chronic HCV infection among UAM Survey participants using services in the North West mirrored the England trend between 2015 and 2024. The prevalence of chronic HCV infection in the North West remained stable up to 2018 at 52% to 54%. Since 2018 there has been a steady decline in the proportion of participants with chronic HCV to 8.3% in 2024.

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

A total of 51% of UAM Survey participants using services in the North West self-reported having a test for HCV in the current or previous year in 2024, which was consistent with the proportion for England overall. Self-reported HCV testing in the North West increased gradually among participants between 2015 and 2024 from 36% to 51%. This mirrored the England trend.

Hepatitis C treatment pathway

Figure 17. Treatment pathway in North West 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 84.6% of individuals with chronic hepatitis C were linked to treatment. 98.5% of those linked to treatment had started treatment. 83.3% of individuals with chronic hepatitis C had started treatment, meeting the WHO elimination target for treatment coverage (≥80%). 91.4% of those who started treatment had a recorded outcome. 96.3% of those with an outcome recorded achieved SVR (sustained virological response). 88.1% of those who started treatment achieved SVR.

Treatment pathway by operational delivery network (ODN)

1) Cheshire and Merseyside ODN

Figure 18. Treatment pathway by operational delivery network (ODN) in Cheshire and Merseyside ODN, 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.

See notes 24 and 25

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

Note 26: ODN boundaries do not fully align with UKHSA regional boundaries, so not all North West residents may be captured in these ODN charts. ODN charts are presented within this report for the region containing the majority of their residents. Consequently, these charts may include cases from outside the region, and some North West residents may be in ODNs falling in other regions, and so included in other regions’ reports.

A total of 3.8% of cases resident in the North West fall into the North East and North Cumbria ODN; data for this ODN is captured in the ‘Spotlight on Hepatitis C in the North East Region’ report.

Between 2015 and 2024 88.9% of individuals with chronic hepatitis C were linked to treatment. 98.9% of those linked to treatment had started treatment. 87.9% of individuals with chronic hepatitis C had started treatment, meeting the WHO elimination target for treatment coverage (≥80%). 91.6% of those who started treatment had a recorded outcome. 93.1% of those with an outcome recorded achieved SVR. 85.3% of those who started treatment achieved SVR.

2) Greater Manchester and Eastern Cheshire ODN

Figure 19. Treatment pathway by operational delivery network (ODN) in Greater Manchester and Eastern Cheshire ODN, 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.

See notes 24, 25 and 26

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

A total of 3.8% of cases resident in the North West fall into the North East and North Cumbria ODN. Data for this ODN is captured in the Hepatitis C in the North East report.

Between 2015 and 2024 81.3% of individuals with chronic hepatitis C were linked to treatment. 98.6% of those linked to treatment had started treatment. 80.1% of individuals with chronic hepatitis C had started treatment, meeting the WHO elimination target for treatment coverage (≥80%). 90.7% of those who started treatment had a recorded outcome. 98.8% of those with an outcome recorded achieved SVR. 89.6% of those who started treatment achieved SVR.

3) Lancashire and South Cumbria ODN

Figure 20. Treatment pathway by operational delivery network (ODN) in Lancashire and South 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, 25 and 26

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

A total of 3.8% of cases resident in the North West fall into the North East and North Cumbria ODN. Data for this ODN is captured in the ‘Spotlight on Hepatitis C in the North East Region’ report.

Between 2015 and 2024 85.7% of individuals with chronic hepatitis C were linked to treatment. 97.6% of those linked to treatment had started treatment. 83.6% of individuals with chronic hepatitis C had started treatment, meeting the WHO elimination target for treatment coverage (≥80%). 92.6% of those who started treatment had a recorded outcome. 96.9% of those with an outcome recorded achieved SVR. 89.7% of those who started treatment achieved SVR.

Reinfections in individuals initiating treatment

For people who initiated treatment between 2015 and 2024 in the North West, the reinfection rate was 4.8 per 100 person-years (95% CI 4.5 to 5.1), 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 6.6 per 100 person-years (95% CI 6.1 to 7.1), again lower than the England estimate (8.8 per 100 person-years, 95% CI 8.5 to 9.0). For individuals whose last injection was more than 3 years earlier, the rate was 2.9 per 100 person-years (95% CI 2.5 to 3.3), again lower than the England estimate (4.0 per 100 person-years, 95% CI 3.8-4.2). Among people with any history of imprisonment before starting treatment, the reinfection rate was 6.8 per 100 person-years (95% CI 6.1 to 7.5), also lower compared with England (9.4 per 100 person-years, 95% CI 9.0 to 9.7).

Monitoring HCV-related morbidity

Hospital admissions from HCV

Figure 21. Number of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), North West 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 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.

Hepatitis C virus-related morbidity can be estimated by monitoring the number of new cases of hepatitis C-related ESLD and/or HCC each year. The data is presented as a range with a lower and upper bound. The figures show the estimated number of first hospital admissions for ESLD and/or HCC for each year between 2010 and 2024 for North West residents and England overall. Data was missing for the financial year 2017 to 2018. In the North West, estimated admissions declined from 302 to 344 in 2012 to 136 to 177 in 2024, with some year-to-year fluctuation. In England, estimated admissions rose steadily between 2010 and 2016 and then declined steadily between 2019 and 2024 to return to a similar level to 2010.

Figure 22. Rate per 100,000 of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), North West 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 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.

Hepatitis C virus-related morbidity can be estimated by monitoring the number of new cases of hepatitis C-related ESLD and/or HCC each year. The data is presented as a range with a lower and upper bound. The figures show the estimated rate of first hospital admissions for ESLD and/or HCC for each year between 2010 and 2024 for North West residents and England overall. Data was missing for the financial year 2017 to 2018. In the North West, the estimated admission rate declined from 4.27 to 4.86 per 100,000 in 2012 to 1.76 to 2.29 per 100,000 in 2024, with some year-to-year fluctuation. In England, the estimated admission rate rose steadily between 2010 and 2016 and then declined steadily between 2019 and 2024 to return to a similar level to 2010.

HCV-related mortality

Figure 23. Number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), North West UKHSA region, 2005 to 2024

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

The estimated number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC) in North West residents increased from 2005 (27 to 43 deaths) and peaked in 2014 (72 to 133 deaths). From 2014 to 2024 there was an overall declining trend in the estimated number of deaths to a range of 24 to 90, with the exception of 2019 (73 to 136 deaths).

Figure 24. 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 North West had the highest estimated mortality rate for hepatitis-C-related ESLD and/or HCC in England between 2020 and 2024, together with London (1.9 per 100,000). This was higher than the England rate (1.3 per 100,000). The Yorkshire and Humber, South West and South East regions had an estimated mortality rate of 1.11 to 1.15 per 100,000, East and West Midlands 0.91 to 1.10 per 100,000 and North East and East of England 0.0 to 0.9.

Prevention of infection by harm reduction

Figure 25. Reported level of direct sharing of needles/syringes among people who inject drugs (PWID), in the preceding 4 weeks, North West 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.

The proportion of UAM Survey participants who reported direct sharing of needles/syringes in the preceding 4 weeks gradually increased for the North West between 2015 and 2024 from 14.9% to 29.6%. There was a similar but more gradual increase in England over the same period (16.7% to 24.8%).

Figure 26. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID), in the preceding 4 weeks, North West 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.

The proportion of UAM Survey participants who reported direct and indirect sharing of needle, syringe and other injecting paraphernalia in the 4 weeks before completing the UAM Survey gradually increased for the North West between 2015 and 2024 from 33.9% to 48.0%. There was a more gradual increasing trend for England over the same period, rising from 38% to 44.3%.

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 the 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 FES.NorthWest@ukhsa.gov.uk

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