Summary of Hepatitis B and Hepatitis C Elimination Efforts Across Primary Care in England

Primary care has become an increasingly important setting for England’s efforts to eliminate hepatitis B (HBV) and hepatitis C (HCV) as public health threats. Working alongside specialist services, Operational Delivery Networks (ODNs), community providers, drug and alcohol services, and public health teams, general practice plays a key role in identifying undiagnosed infections, supporting treatment pathways, and preventing onward transmission.

Increasing Case Finding and Testing

A major focus of elimination activity has been improving the identification of people living with undiagnosed viral hepatitis. General practice is often the first point of contact with healthcare services and provides opportunities to test individuals from groups at increased risk, including people who inject drugs, migrants from countries with higher viral hepatitis prevalence, people experiencing homelessness, prison leavers, and those with abnormal liver function tests. ODNs work closely with primary care to promote routine and targeted testing, ensuring that more people are diagnosed at an earlier stage of infection.

Primary care has also supported national initiatives aimed at reducing the number of people unaware of their infection, including opportunistic testing (The-Hattersley-Testing-Event-Pilot-Final.pdf), recalls of patients who may be at risk, and participation in local case-finding programmes (Hepatitis C Case Finding in a North West London Primary Care Pilot). These efforts contribute to the World Health Organisation (WHO) goal of diagnosing at least 90% of people living with viral hepatitis.

Information, guidelines for case finding using search tools, education and resources for general practice can be found here: General Practice – HEP C U Later

Hepatitis C Elimination Through Community-Based Treatment

The introduction of direct-acting antiviral (DAA) medicines has transformed hepatitis C care. These treatments cure more than 95% of infections, are well tolerated, and can often be delivered outside hospital settings. As a result, many ODNs have developed shared-care and outreach models that enable treatment to be initiated and supported through community services and primary care.

Primary care clinicians support hepatitis C elimination by identifying patients, arranging diagnostic investigations, referring into treatment pathways, monitoring progress, and encouraging re-engagement with care for patients who have previously disengaged. These simplified pathways have helped England achieve high treatment rates and substantial reductions in hepatitis C prevalence.

Improving Hepatitis B Diagnosis and Long-Term Management

Unlike hepatitis C, hepatitis B cannot usually be cured, but effective antiviral treatments can suppress the virus and prevent serious liver disease. Primary care plays a crucial role in identifying patients with chronic hepatitis B, facilitating referral to specialist services, and supporting ongoing monitoring and surveillance. ODNs and specialist networks work with general practice to ensure patients receive appropriate long-term care, including liver disease assessment, monitoring for hepatocellular carcinoma where indicated, and timely access to treatment.

Prevention and Vaccination

Primary care also contributes to hepatitis elimination through prevention activities. For hepatitis B, this includes delivering vaccination programmes to eligible populations, supporting antenatal screening pathways, and ensuring contacts of people who have the infection are offered vaccination where appropriate. Practices also provide education on reducing transmission risks and encourage uptake of harm reduction services for those at ongoing risk of infection.

For hepatitis C, prevention efforts focus on education, re-testing of individuals with ongoing risk, and linkage to needle and syringe programmes and drug treatment services that help reduce transmission among people who inject drugs.

Collaborative Working and Elimination Goals

England’s hepatitis elimination programme relies on strong partnerships between primary care, ODNs, local authorities, public health agencies, drug treatment services, community organisations, and specialist hepatology and infectious disease services. ODNs are specifically commissioned to oversee testing, treatment, and patient pathways across local health systems and to ensure equitable access to care for underserved populations.

These coordinated efforts have contributed to a sustained decline in hepatitis C prevalence, increased access to curative treatment, and progress towards the WHO elimination targets for viral hepatitis. However, challenges remain in finding undiagnosed individuals, improving engagement among vulnerable populations, and reducing new infections and reinfections.

Conclusion

Primary care is central to England’s hepatitis B and hepatitis C elimination strategy. Through targeted testing, case finding, vaccination, linkage to specialist care, community-based treatment models, and long-term patient management, general practice is helping to identify undiagnosed infections, improve access to treatment, and reduce the burden of viral hepatitis across England. Working in partnership with ODNs, drug treatment services, and community services, primary care continues to play a vital role in achieving national and global elimination goals.