Research and analysis

Hepatitis C in the South West annual report 2025

Published 8 October 2026

Applies to England

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 South West UKHSA region with data up to the end of 2024.

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

Summary

Key findings for hepatitis C testing:

• there were 1,400 new laboratory reports of hepatitis C in residents of the South West UKHSA region, representing a rate of 23.8 reports per 100,000 population in 2024
• the number of new laboratory reports has increased by 35.3% since 2023 and increased by 22.1% over the past 10 years
• in 2024, the number of positive laboratory reports by upper tier local authority of residence ranged from 16 in Swindon to 254 in Somerset. Rates were highest in Bristol at 43.3 and lowest in Swindon with 6.6
• in 2024, the number of laboratory reports in males was 654 (46.7%) and in females was 398 (28.4%). Sex was not recorded in 24.9% of cases
• in 2024, the highest number of laboratory reports was observed in the 35 to 44 year age group for both sexes, with 169 cases in males and 99 cases in females
• there have been 60,017 individuals tested for anti-HCV in sentinel laboratories in the South West UKHSA region in 2024, of which 1.9% 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 6,899 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), 6,753 started treatment within 90 days and 5,768 achieved a sustained viral response (SVR), in South West UKHSA region between 2015 and 2024

Key findings for HCV-related morbidity and mortality:

• there have been 57 hospital admissions for individuals with a diagnostic code for hepatitis C-related end-stage liver disease or hepatitis C-related hepatocellular carcinoma in the South West UKHSA region in 2024; with an upper-bound estimate of up to 82 admissions. This was lower than in 2023 (hospital admissions: 94)
• there was a lower bound estimate of 26 registered deaths from hepatitis C–related end‑stage liver disease and/or hepatocellular carcinoma in the South West in 2024; with an upper‑bound estimate identifying up to 50 deaths. This was higher than in 2023 (lower bound estimated deaths: 9)

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 South 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.

Counts of hepatitis C laboratory reports in the South West rose in the 2 years following the 2020 to 2021 COVID-19 pandemic (Figure 1), reversing a sustained decrease between 2017 and 2021 (from 1105 to 842 reports). In 2024, the number of annual HCV laboratory reports increased again by 35%, from 1035 in 2023 to 1400 in 2024.

As indicated in Note 1, a new ‘opt-out’ bloodborne virus (BBV) testing programme was introduced in 2022 for selected emergency departments (ED) in areas of high HIV diagnosed prevalence across England. During the first 2 years of the programme, no providers based in the South West were included. In 2024, the programme was expanded to include 46 additional sites nationally, including 5 hospitals in Bournemouth, Poole, Bristol, and Weston-super-Mare.

Recent increases in cases in the South West are likely related to improved detection in populations who are less likely to be diagnosed through traditional pathways. Early evaluations of the national ‘opt-out’ programme indicate that BBV patients identified were more likely to be older and from ethnic minority backgrounds, and differed from those diagnosed in other settings in terms of their routes of acquisition and risk factors. Additionally, over 70% of those diagnosed through the national programme had no prior record of BBV testing.

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

Within the last 10 years, hepatitis C incidence in the South West has been low, and the annual regional rate of HCV laboratory reports per 100,000 population has consistently fallen beneath the rate for England (Figure 2). Unlike the South West, HCV rates in England were stable between 2015 and 2019 before sharply decreasing during periods of service disruption in the first year of the 2020 to 2021 COVID-19 pandemic. National incidence rates have since rebounded to pre-pandemic levels, with notable increases in 2022 and 2024 during the introduction and expansion of the BBV opt-out testing programme.

Regional incidence rates of HCV laboratory reports rose from 17.8 in 2023 (95% CI 16.7 to 18.9) to 23.8 in 2024 (95% CI 22.5 to 25), coinciding with the 2024 expansion of the national ED opt-out programme to sites in the South West. This marks the highest annual incidence rate of hepatitis C in the South West in the previous 10 years, but this trend is likely linked to improved detection of HCV among populations not attending traditional testing settings (Figure 1).

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.

Compared to other English regions, the 2024 rate of new HCV laboratory reports in the South West (23.8) was higher than in the East of England (12.9), the West Midlands (18.8), and the South East (19.7), and lower than in the East Midlands (26.6), Yorkshire and the Humber (26.7), the North East (32.2), the North West (35.8), and London (50.1) (Table 1). Cases in the South West made up 8% of the total for England, consistent with previous years. Incidence rates in 2024 increased in all regions except the North West and South East, which participated in the initial 2022 pilot of the BBV ED opt-out testing programme.

The 2024 rate in London is the highest reported in any English region over the previous 10 years and follows 3 years of participation in the national ED opt-out programme, during which HCV lab report rates rose from 30.7 per 100,000 in 2021, before entering the programme, to 50.1 in 2024. Increased detection of HCV through the expanded programme is likely to affect incidence rates for all English regions in the coming years.

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
Bath and North East Somerset	Count	36	29	15	30	29	25	26	36	27	43
Bath and North East Somerset	Rate	19.7	15.6	8.0	15.8	15.2	13.0	13.5	18.4	13.6	21.5
Bournemouth, Christchurch and Poole	Count	94	93	119	65	95	167	46	100	98	97
Bournemouth, Christchurch and Poole	Rate	23.9	23.4	29.8	16.2	23.7	41.8	11.5	24.8	24.1	23.7
Bristol	Count	257	213	273	230	229	183	151	142	178	214
Bristol	Rate	56.9	46.3	58.9	49.2	48.7	38.8	32.0	29.6	36.6	43.3
Cornwall and Isles of Scilly	Count	75	71	38	57	56	51	34	33	54	52
Cornwall and Isles of Scilly	Rate	13.6	12.8	6.8	10.1	9.9	9.0	5.9	5.7	9.3	8.9
Devon	Count	113	77	46	24	39	66	162	120	121	85
Devon	Rate	14.7	10.0	5.9	3.0	4.9	8.2	19.9	14.5	14.5	10.1
Dorset	Count	25	20	22	22	39	40	31	42	39	42
Dorset	Rate	6.7	5.4	5.9	5.9	10.3	10.6	8.1	11.0	10.1	10.8
Gloucestershire	Count	121	124	103	76	106	101	119	152	74	164
Gloucestershire	Rate	19.6	19.9	16.4	12.0	16.6	15.8	18.4	23.3	11.2	24.5
North Somerset	Count	61	45	43	40	49	45	27	22	41	57
North Somerset	Rate	29.0	21.2	20.1	18.7	22.7	20.8	12.4	10.0	18.5	25.4
Plymouth	Count	53	46	53	30	62	31	47	90	81	111
Plymouth	Rate	20.1	17.4	20.0	11.3	23.4	11.7	17.8	33.6	29.9	40.8
Somerset	Count	135	138	188	207	87	87	46	60	165	254
Somerset	Rate	24.6	24.9	33.6	36.8	15.4	15.4	8.0	10.4	28.3	43.2
South Gloucestershire	Count	34	48	55	60	53	43	63	57	55	108
South Gloucestershire	Rate	12.5	17.4	19.8	21.3	18.6	15.0	21.7	19.3	18.3	35.3
Swindon	Count	38	51	56	55	23	5	13	18	11	16
Swindon	Rate	17.1	22.7	24.6	23.9	9.9	2.1	5.6	7.6	4.6	6.6
Torbay	Count	35	31	19	18	10	10	5	17	8	19
Torbay	Rate	25.9	22.8	13.8	13.0	7.2	7.2	3.6	12.2	5.7	13.6
Wiltshire	Count	70	79	75	78	76	53	62	57	83	138
Wiltshire	Rate	14.3	16.0	15.1	15.6	15.1	10.5	12.1	11.0	16.0	26.4
No UTLA data available	Count	0	0	0	2	4	6	10	1	0	0
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.

Within the South West, the highest rates of HCV laboratory report incidence in 2024 were from Bristol (43.3 per 100,000 residents), Somerset (43.2), and Plymouth (40.8), while the lowest rates were from Swindon (6.6), Cornwall and the Isles of Scilly (8.9), and Devon (10.1).

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

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

Most hepatitis cases reported in 2024 in the South West were male (62.2%, Figure 3). New reports of hepatitis C were most frequently seen in women and men aged 35-44 years. In men a decreasing number of new reports were seen with increasing age after 34 years. These age-sex profiles are consistent with national data.

Among males, the largest numbers of reports originated from those aged 35 to 44 (169), 45 to 54 (148), and 55 to 64 (124). Among females, the highest numbers of reports were among those aged 35 to 44 (99), 65 and over (83), and 25 to 34 (76).

Figure 4. Ethnicity distribution of new laboratory reports of hepatitis C, residents of South 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. (33.3% 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.

Over 90% of new hepatitis C diagnoses in the South West in 2024 were reported among individuals from White ethnic groups, where ethnicity was known (Note 5, Figure 4). Proportions of ethnicity among new diagnoses have remained relatively consistent over the previous 10 years, mirroring the background population of the South West, where 87.8% of residents identified as White British in the 2021 Census. In 2024, 10.2% of new cases were reported among White residents of non-British backgrounds, which is disproportionately higher than the number of non-British White residents in the South West (5.3%). This percentage has remained stable within the last 10 years with a slight decline from a peak of 14.2% in 2015.

In the last 2 years, an increasing percentage of reports in the South West have been from Asian or Asian British residents, with 4.1% of all hepatitis C diagnoses in 2024 related to this group. The proportion of cases among Asian or Asian British residents in 2024 is the highest in the preceding 10-year period and can be compared with a background population of 2.8% of all residents.

HCV testing in the wider population

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

Trends in this section are derived from a subset of laboratories participating in the Sentinel Surveillance of Blood Borne Virus (SSBBV) programme. Data from sentinel laboratories can provide limited information on trends in testing activity in the South West but should be interpreted in context, as there is currently only one site located in the South West (Bristol Royal Infirmary). Trends in the Bristol area may not apply to other parts of the region.

The number of individuals completing hepatitis C antibody tests annually at sentinel sites has more than doubled over the previous 10 years, from 18,673 tests in 2015 to 60,017 in 2024 (Figure 5). The largest increase in testing occurred between 2023 and 2024, rising by 66%. Concurrently, test positivity declined from a peak of 3.3% (95% CI 3.1% to 3.5%) in 2021 to 1.9% (95% CI 1.8% to 2.0%) in 2024.

The 2024 increase in antibody testing is likely linked to the expansion of the opt-out ED BBV programme, leading to increased numbers of tests being conducted at sentinel surveillance sites (note 7).

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

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

Figure 6 shows patterns in testing and test positivity through GP surgeries reporting to sentinel laboratories in the South West. These trends are similar to those in Figure 5, with a steady increase in the number of anti-HCV tests recorded over the previous 10 years, from 5,423 in 2015 to 14,032 in 2024. Compared to the previous figure, a more modest rise in testing is reflected from 2023 to 2024 (+7%), which is consistent with trends related to the rollout of ED HCV opt-out testing described above and in Figure 9.

Anti-HCV test positivity at GPs linked to sentinel sites has remained consistent, being between 0.8% and 1.2% in the previous ten years, except for a small period of elevated detection in 2016 (1.7%, 95% CI 1.4% to 2.1%).

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

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

Testing at sexual health services (SHSs) linked to sentinel sites in the South West decreased markedly from 4,648 tests in 2019 to 2,446 tests in 2020, reflecting a fall in face-to-face SHS consultations and changes to service provision resulting from the COVID-19 pandemic (Figure 7). Following the pandemic, hepatitis C antibody test counts at these SHSs have increased, stabilising at a lower level compared to the 2 years immediately before the pandemic. Between 2023 and 2024, the number of individuals tested at SHSs linked to sentinel sites increased by 7%, from 3,762 tests to 4,030 tests.

Test positivity remained consistent from 2015 to 2019 and throughout the pandemic, before decreasing year-on-year to 0.9% (95% CI 0.7% to 1.3%) in 2024, down from 1.0% (95% CI 0.7% to 1.4%) in 2023. However, these percentages must be interpreted with caution in the context of wide confidence intervals, which suggest that there is limited evidence of a meaningful difference in test positivity before and after the COVID-19 pandemic.

Please note that there is currently only one BBV sentinel site located in the South West (Bristol Royal Infirmary), and testing practices at SHSs in the Bristol area may differ from other providers within the South West.

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

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

People who inject drugs (PWID) are a group at particular risk of acquiring hepatitis C infection. Figure 8 shows testing and test positivity through drug services linked to sentinel laboratories in the South West. 

Testing at drug services linked to sentinel laboratories in the South West increased by over 300% between 2020 and 2024, from 800 tests to 3,262 tests. Improved hepatitis C testing and linkage to care at drug and alcohol services (DTS) are key goals of the NHS England hepatitis C elimination programme. Several initiatives to improve testing at these services were set up in late 2020, namely the HCV Drug Treatment Services Provider Forum, alongside numerous local micro-elimination efforts at non-partner providers. Support for people who inject drugs (PWID) not attending DTSs was similarly established through the Hepatitis C Antibody Testing Service in September 2020. Additional funding was allocated to local authorities in 2022 for improvements to drug and alcohol treatment services.

Due to the disproportionate prevalence of hepatitis C in PWID, test positivity in DTSs is higher in comparison to other services (Figures 5 to 7, Figure 9). Test positivity increased with reduced testing between 2017 and 2020 before reaching a peak of 29.5% (95% CI 26.4% to 32.7%). Following the scale-up of testing in DTSs in 2020, test positivity decreased to a low of 16.0% (95% CI 14.8% to 17.33%) in 2024.

Please note that there is currently only one BBV sentinel site located in the South West (Bristol Royal Infirmary). The demographics of people who inject drugs and the nature of services provided in the Bristol region may differ from other areas of the South West. Several DTSs in the Bristol and Severn Operational Delivery Network achieved micro-elimination status during the 2020 to 2024 period and reduced test positivity in 2024 may not reflect trends across the region.

Figure 9. Number of individuals tested for anti-HCV by year and percentage positive, through emergency departments, in sentinel laboratories in South 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 to skew trends.

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

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

Figure 9 shows patterns in testing and test positivity through emergency departments linked to sentinel laboratories in the South West. Fewer than 1,500 tests were performed annually in these settings prior to 2024, during which the national ED BBV opt-out testing programme was expanded to include sites in the South West. Between 2023 and 2024, the number of individuals tested increased from 1,050 to 19,740. The large increase in testing volume has corresponded with a slight decrease in test positivity, from 1.1% in 2023 (95% CI 0.7% to 2.0%) to 0.9% (95% CI 0.8% to 1.0%) in 2024, which suggests no clear evidence of a change in positivity between these 2 years.

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.

Within the last 5 years, test positivity at sentinel sites in the South West was highest in community outreach programmes (26.1%), drug treatment services (17.0%), and services within prisons (7.6%, Figure 10). This is also true nationally, where testing yield remains highest at these 3 forms of services. Despite the success of the national ED opt-out testing programme and recent increases in new diagnoses originating at emergency departments, past or current injecting drug use remains the most important risk factor for acquiring HCV infection in the UK, and DTSs remain a principal setting for HCV testing and treatment in the South West.

Please note that this figure represents combined 5-year data for 2020 through 2024 and South West participation in the national ED opt-out testing programme commenced in 2024; the proportion of new diagnoses linked to accident and emergency settings at sentinel sites may rise in future reports.

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.

Note 20: ODN boundaries do not fully align with UKHSA regional boundaries, so not all South 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.

Figure 11 shows the annual test positivity for hepatitis C antibody testing by operational delivery network (ODN) in England in 2024. Operational delivery networks are NHS structures comprised of providers, commissioners, community services, and patients. Numbers next to bars indicate the number of positive cases.

ODN boundaries do not fully align with UKHSA regional boundaries, so not all South 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.

There are 2 major ODNs based in the South West, highlighted in royal blue: the South West Peninsula ODN, containing Cornwall, Devon, the Isles of Scilly, Plymouth, Torbay, and western portions of Somerset, and the Bristol and Severn ODN, which contains Bristol, Gloucestershire, North Somerset, South Gloucestershire, and eastern portions of Somerset, as well as western Wiltshire. The Bristol and Severn ODN contains one SSBBV site (Bristol Royal Infirmary), while there are not yet any SSBBV sites in the South West Peninsula ODN.

Additionally, treatment centres in Swindon are housed in the Thames Valley ODN, based in Oxford, while services in Bournemouth, Christchurch and Poole, Dorset, and the remainder of Wiltshire participate in the Wessex ODN, based in Southampton. Within these ODNs, there are 2 SSBBV sites, in Oxford and Portsmouth.

Limited testing data is available from ODNs without a SSBBV sentinel site, largely originating from drug treatment centres, which exhibit elevated test positivity rates due to the higher prevalence of HCV among PWID (Figure 8). Therefore, positivity rates from these ODNs must be interpreted in context.

Among the ODNs serving populations in the South West, test positivity was highest in the South West Peninsula ODN (18.4%), followed by Thames Valley (7.9%), Wessex (2.5%), and Bristol and Severn (1.6%). The total number of tests delivered was greatest in the Bristol and Severn ODN (176,057), where 2 hospitals are participating in the national ED opt-out testing programme, followed by Wessex (124,184), Thames Valley (12,994), and South West Peninsula (9,575).

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

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

Unlike anti-HCV tests, HCV RNA testing reflects active infections, including reinfections. RNA testing is usually performed after an individual tests positive for hepatitis C antibodies to confirm that they are living with the virus, although RNA or core antigen testing is sometimes performed as a first-line test.

RNA test positivity at sentinel sites in the South West has significantly decreased within the previous 10 years, from 43.3% (95% CI 42.0% to 44.7%) in 2015 to 13.3% in 2024 (95% CI 12.5% to 14.1%, Figure 12). This can be associated with a decline in new diagnoses from 2015 to 2022 (Figure 1) and increased testing volumes among a wider population of lower-risk non-PWID in 2023 and 2024: counts of RNA tests rose from 5,767 tests in 2022 to 7,142 in 2023 and 7,413 in 2024. These trends are mirrored nationally, where RNA test positivity decreased from a peak of 42.1% in 2016 to 12.2% 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 for further explanation about ODN boundaries.

Among the 4 ODNs serving South West residents (Figure 11), HCV RNA test positivity was highest within the South West Peninsula ODN (37.7%), followed by Thames Valley (28.2%), Wessex (24.4%), and Bristol and Severn (15.3%, Figure 13). Across all English ODNs, South West Peninsula had the highest RNA test positivity, although testing reported from this ODN likely differs from others in terms of its patient demographics (Figure 11) and cannot be directly compared to ODNs containing SSBBV sites.

ODN boundaries do not fully align with UKHSA regional boundaries, so not all South 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.

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), South 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.

Data in this section is sourced from the UAM Survey, a voluntary survey of PWID attending specialist services, including needle and syringe programmes and addiction treatment centres, across England and the South West.

The proportion of UAM respondents in the South West who self-reported having ever been infected with HCV, including those who have cleared the virus, has remained stable throughout the last 10 years, with 48.7% reporting a historic HCV infection in 2015 compared to 47.8% in 2024 (Figure 14). This is closely aligned with national trends, where lifetime HCV infection prevalence among PWID has been between 50% and 60% for the last 10 years. A stable trend in this indicator may be associated with an ageing population of HCV antibody-positive individuals who are living longer following treatment.

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

The proportion of UAM respondents self-reporting chronic HCV infections fell substantially between 2015 in the South West and across England (Figure 15). In the South West, chronic HCV prevalence decreased from a peak of 59.3% in 2016 to 10.9% in 2024, compared to a national decrease from 56.5% in 2016 to 9.9% in 2024.

Statistical modelling performed as part of the EPIToPE Study using UAM Survey data has provided strong evidence for an association between community scale-up of treatment and reductions in chronic hepatitis C prevalence. This evidence supports the effectiveness of treatment as prevention in 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, South 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.

The proportion of UAM respondents in the South West stating that they were recently tested for HCV was above the national percentage and increased year-on-year from 2015 (40.3%) to 2020 to 2021 (55.6%), before dropping to 42.8% following the COVID-19 pandemic and remaining below 50% in subsequent years (Figure 16). In 2024, 42.6% of South West UAM respondents reported being recently tested for HCV. Concurrently, testing among UAM respondents increased nationally from 45.4% in 2020 to 2021 to 52.6% in 2024.

These trends diverge from those indicated by sentinel surveillance (Figure 8), which may be due to differences in testing provision for PWID in areas outside of the Bristol region who are not captured in SSBBV data.

Figure 17. Treatment pathway in South 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.

According to WHO elimination targets, 80% or more of those with hepatitis C should be linked to treatment, where treatment coverage is defined as the proportion of individuals living with diagnosed chronic hepatitis C who initiated treatment during a specified time frame.

In England, hepatitis C testing and treatment data has been used to follow individuals through the care pathway. This data is used to monitor progress towards the WHO target and to identify gaps in care and/or monitoring.

Figure 17 displays the treatment outcomes of the 10,868 South West residents living with chronic hepatitis C during the 10-year period from 2015 to 2024. Of these individuals, 5,768 (53.1%) achieved sustained virologic response (SVR) status by the end of 2024. Patients are said to have achieved SVR when a negative HCV RNA PCR test is returned 12 weeks after completing an antiviral treatment programme. Individuals with SVR are considered to be cured from HCV, as they cannot transmit the virus to others and are extremely unlikely to be reinfected. In about 24% of cases, hepatitis C resolves without treatment, which is referred to as spontaneous clearance.

Of those identified with chronic hepatitis C, 25.9% were ineligible to receive treatment, with 1,772 individuals (16.3%) lost to follow up due to missing patient information, 476 (4.4%) dying before entering treatment, and 457 (4.2%) obtaining a negative HCV RNA PCR result before entering treatment, possibly indicating spontaneous clearance.

Among the remaining 8,163 people eligible for treatment, 84.5% were linked to an NHSE treatment database, and 82.7% are recorded in these databases as having started a treatment programme. Among those offered treatment, an outcome was recorded for 6,091 individuals (92.5%), including 5,768 patients achieving SVR (92.4%), 153 patients testing positive for HCV after treatment (2.4%), and 146 deaths before treatment completion (2.2%).

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

Treatment pathway by operational delivery network (ODN)

1) Bristol and Severn ODN

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

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

See notes 24 and 25.

The Bristol and Severn ODN contains services in Bristol, Bath and North East Somerset, Gloucestershire, North Somerset, South Gloucestershire, and portions of northern and eastern Somerset as well as northwestern Wiltshire. Treatment pathway outcomes in this ODN (Figure 18) were similar to those for the South West (Figure 17). Those in the Bristol and Severn ODN had a slightly lower proportion commencing treatment (82.4%, compared to 82.7%), although a higher proportion of those on treatment recorded an outcome (93.7%) and achieved SVR (87%). These trends may relate to differences in the populations served by this ODN.

ODN boundaries do not fully align with UKHSA regional boundaries, so not all South West 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.

2) South West Peninsula ODN

Figure 19. Treatment pathway by operational delivery network (ODN) in South West Peninsula 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.

The South West Peninsula ODN contains services in Cornwall, Devon, the Isles of Scilly, Plymouth, Torbay, and western and southern portions of Somerset. Treatment pathway outcomes in this ODN (Figure 19) were similar to those for the South West (Figure 17). Those in the South West Peninsula ODN had a slightly higher proportion commencing treatment (85.7%, compared to 82.7%), although a higher proportion of those on treatment recorded an outcome (91.4%) and a lower proportion achieved SVR (83.0%). These trends may relate to differences in the populations served by this ODN.

ODN boundaries do not fully align with UKHSA regional boundaries, so not all South West 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.

Other South West local authorities

Certain regions of the South West are not included in either the Bristol and Severn or South West Peninsula ODNs. Providers in Swindon, covering 4.3% of all hepatitis C cases resident in the South West, are housed in the Thames Valley ODN based in Oxford. Services in Bournemouth, Christchurch and Poole, Dorset, and portions of eastern and southern Wiltshire participate in the Wessex ODN, based in Southampton. Data for these ODNs can be found in the 2025 report for South East England.

Reinfections in individuals initiating treatment

For people who initiated treatment between 2015 and 2024 in the South West, the reinfection rate was 5.8 per 100 person-years (95% CI 5.3 to 6.3), which was slightly 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 three years prior to treatment initiation, the reinfection rate was 7.3 per 100 person-years (95% CI 6.6 to 8.1), which was lower than the England estimate. For individuals whose last injection was more than three years earlier, the rate was 3.8 per 100 person-years (95% CI 3.1 to 4.6), which was slightly lower than the England estimate. Among people with any history of imprisonment before starting treatment, the reinfection rate was 10.2 per 100 person-years (95% CI 8.9 to 11.7), which was slightly higher than the England estimate.

Monitoring HCV-related morbidity

Hospital admissions from HCV

Figure 20. Number of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), South 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 26: 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 27: 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 28: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 29: data based on HES as of December 2025.

End-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) are 2 major contributors to hepatitis C-related morbidity and mortality, caused by severe chronic damage and scarring (cirrhosis and fibrosis) to the liver. ESLD covers a broad range of symptoms (Note 30) and it is difficult to obtain a precise number of ESLD/HCC deaths due to HCV infection.

This data is presented as a range with a lower and upper bound. The lower bound is based on Hospital Episode Statistics (HES) data only and represents incident cases of ESLD and/or HCC which have been linked to an episode of hepatitis C in HES from any year. This approach may result in underreporting of hepatitis C, as it relies on a diagnosis of hepatitis C being recorded in HES. Therefore, an upper bound is presented, which uses HES data linked to laboratory diagnoses of hepatitis C from Second Generation Surveillance System (SGSS). The upper bound represents incident cases of ESLD and/or HCC that have been linked to an episode of hepatitis C in HES or a laboratory diagnosis of hepatitis C from any year. The method was applied to previous years to get a full time series using the new methodology, although data is not available for certain years (Note 28).

Overall hospital admissions for hepatitis C-linked ESLD/HCC in the South West have decreased since 2012, when a peak of between 143 and 154 attendances were recorded. In 2024, there were between 57 and 82 attendances, lower than any estimate identified using this methodology since 2011. Similarly, a peak of between 2,008 and 2,132 attendances were reported nationally in 2016, with a year-on-year decrease since 2019. In 2024, between 1,165 and 1,409 ESLD/HCC attendances were reported nationally, with the lower bound indicating the lowest estimate recorded in the previous 15 year period. These trends indicate an overall reduction in hepatitis C morbidity within the last 10 years, possibly related to improved testing and access to treatment.

Figure 21. Rate per 100,000 of first hospital admissions for hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), South 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 30: 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 31: 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 32: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Note 33: data based on HES as of December 2025.

Figure 21 presents the data contained in Figure 20 as rates per 100,000 residents. In 2024, the rate of hospital admissions for hospital-related ESLD and/or HCC was between 1.0 and 1.4 in the South West, compared to a range of 2.0 to 2.4 in England. Regional rates have been lower than or similar to national rates over the 15-year period from 2010 to 2024.

HCV-related mortality

Figure 22. Number of deaths from hepatitis C-related end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC), South West UKHSA region, 2005 to 2024

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

Hepatitis C virus-related mortality is an important measure of progress towards hepatitis C elimination because it monitors whether services are promptly diagnosing and treating people living with hepatitis C. Prompt diagnosis and treatment reduces the number of deaths related to hepatitis C virus by ensuring early clearance of the virus before it can cause damage to the liver.

The combined hepatitis C and hepatitis B absolute target for mortality is equal to or less than 6 per 100,000 population. Previously, the mortality targets separated hepatitis B and hepatitis C at 4 per 100,000 and 2 per 100,000 persons respectively.

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.

In the South West, the estimated number of annual hepatitis C-associated ESLD and/or HCC deaths has been between 9 and 55 in the previous 20-year period, equivalent to a crude annual mortality rate of less than 6 deaths per 100,000 persons, meeting WHO targets.

Figure 23. 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 further information, see Information on data sources.

The 5-year crude mortality rate per 100,000 persons in the South West between 2020 and 2024 is 1.11 (95% CI 1.05 to 1.17), which is similar to most other regions of England, including the East Midlands (0.99, 95% CI 0.93 to 1.06), the South East (1.16, 95% CI 1.11 to 1.21), the West Midlands (1.08, 95% CI 1.02 to 1.14), and Yorkshire and Humber (1.18, 95% CI 1.12 to 1.25) (Figure 23). Compared to the South West, the East of England (0.90, 95% CI 0.85 to 0.95) and the North East (0.82, 95% CI 0.74 to 0.90) had significantly lower crude mortality rates over this period, while London (1.94, 95% CI 1.88 to 2.01) and the North West (1.90, 95% CI 1.83 to 1.97) reported significantly higher rates.

Prevention of infection by harm reduction

Figure 24. Reported level of direct sharing of needles/syringes among people who inject drugs (PWID), in the preceding 4 weeks, South West UKHSA region and England, 2015 to 2024

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

Note 34: 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. See Technical Notes for more details.

Figure 24 shows a stable trend in the percentage of PWID directly sharing needles and/or syringes in the South West. In this figure, needle and/or syringe sharing has been self-reported by UAM Survey respondents and is recorded only if it occurred in the 4-week period prior to the individual’s response. The percentage of direct needle sharing rose nationally from 16.7% in 2015 to 24.8% in 2024, mirrored by a regional increase from 24.2% in 2015 to 26.6% in 2024.

Figure 25. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID), in the preceding 4 weeks, South 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. See Technical Notes for more details.

Regionally, total self-reported equipment sharing decreased continually from 51.8% in 2015 to 41.8% in 2018. This percentage remained at 44.3% during the COVID-19 pandemic before increasing to pre-pandemic levels at 46.9% in 2022 and 51.8% in 2023. In 2024, indirect sharing decreased to 49.5%. Nationally, the percentage of PWID engaging in equipment sharing remained stable until the COVID-19 pandemic, where it rose to 41.4% from 38.0% in 2015. Total equipment sharing in England rose again from 39.8% in 2022 to 44.4% in 2024. Among UAM respondents, the prevalence of equipment sharing in the previous 4 weeks has remained higher in the South West than in England over the previous 10 years.

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

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

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

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

Sentinel Surveillance of Bloodborne Viruses (SSBBV)

Brief description

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

Technical notes

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

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

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

Reinfection

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

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

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

The estimate now includes multiple reinfections, whereby someone is treated after experiencing their first reinfection and achieves an SVR but then has a subsequent hepatitis C virus RNA or core antigen positive result. The data is reliant upon persons initiating treatment being added to the NHSE Blueteq System or NHSE Hepatitis C Patient Registry and Treatment Outcome System, sufficient identifiers being available to link between the treatment and SSBBV databases and on people being tested post treatment. It should be noted that there is no internationally agreed definition for defining hepatitis C reinfection and a different window period may be used to confirm SVR post treatment. For example, Scotland uses a negative test between 10 weeks and 12 months post treatment to confirm SVR. As we progress 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.southwest@ukhsa.gov.uk

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