Expanding the Role of Community Drug and Alcohol Treatment Services in Physical Healthcare: Lessons from Hepatitis C Elimination and the Opportunity of Liver Health Screening

Community drug and alcohol services in England stand at a critical moment of opportunity. Thanks to the remarkable success of the National Hepatitis C Elimination Programme, these services have built strong clinical pathways, outreach capability, and trusting relationships with people who use drugs—many of whom have historically faced barriers engaging with mainstream healthcare, particularly general practice. This evolving landscape provides a powerful foundation for expanding physical healthcare interventions within community drug and alcohol treatment settings, with liver health emerging as one of the most pressing and achievable areas for impact.

The Changing Landscape: Hepatitis C Elimination as a Catalyst

Over the past decade, England has made exceptional progress toward eliminating hepatitis C as a public health threat. Data from the Hepatitis C in England 2024 report show a 56.7% reduction in chronic hepatitis C prevalence between 2015 and 2023 (Hepatitis C in England 2024 – GOV.UK). This was driven largely by incredibly widespread testing and treatment initiatives such as the implementation of the national NHSE hepatitis C testing portal, ED Opt-Out Testing, and initiatives that placed community drug treatment services at the centre of the national response, but which were heavily supported by other key partners across the systems such as Hepatitis C Trust peers, Operational Delivery Networks and the pharmaceutical industry.

Importantly, the UKHSA report highlights that among the population most affected, people who inject drugs, the prevalence of chronic hepatitis C infection has fallen to 7.2%, with nearly double the proportion clearing past infection compared to 2015. This success is attributed to intensive testing and treatment delivered within community drug services, which created accessible points of care for individuals who often face stigma and barriers to accessing other healthcare settings.

This transformation of service capability and culture created something profound: a reliable, trusted gateway through which people who use drugs can receive not only hepatitis C testing and treatment, but broader healthcare interventions as well.

Why Physical Healthcare in Community Drug and Alcohol Treatment Services Matters

People who use drugs frequently experience some of the worst physical health outcomes in the population. They are more likely to live with long‑term conditions, multi-morbidity, and undiagnosed or untreated physical health problems, yet attendance at general practice remains low for many, largely because of stigma, previous negative experiences, geographical barriers, or prioritisation of other pressing needs.

The hepatitis C elimination programme demonstrated that when services are brought to where people already are, and delivered in a way that is non‑judgemental, flexible, and relational, engagement dramatically increases. Community drug and alcohol treatment services have therefore become a critical healthcare access point, often reaching people who interact with no other part of the NHS.

This provides a unique opportunity, with the correct financial investment and uplift in workforce skill-set, to embed physical health interventions at scale, including:

Cardiovascular risk assessment
Diabetes and blood pressure screening
Vaccination programmes
Respiratory health checks
Sexual health testing
Liver disease screening

Of these, liver health could be argued to be a priority, both because of its direct relevance to drug and alcohol use, and because the infrastructure and expertise developed during hepatitis C elimination make it exceptionally achievable.

Liver Health: The Next Frontier

Chronic liver disease is highly prevalent among people accessing community drug and alcohol treatment services, driven not only by hepatitis C, and at much lower levels hepatitis B, but also by alcohol use, obesity, and poor nutrition. Many people remain undiagnosed until symptoms appear at a late stage.

The success of hepatitis C elimination has now created a platform from which liver disease more broadly can be addressed. Community drug and alcohol treatment services already possess:

Skilled staff trained in venepuncture, testing, and harm reduction
Close working relationships with local Hepatitis C Operational Delivery Networks (ODNs), which oversee pathways to specialist liver care (Hepatitis C Care Clinical Network Specification)
Outreach models that bring care to those least likely to attend clinics
Strong peer involvement and stigma‑reduction approaches
Experience of micro‑elimination work within their own populations (What does hepatitis C micro-elimination in drug services mean? – HEP C U Later)

This creates an exceptional opportunity to scale liver health interventions beyond hepatitis C, and one of the most effective tools available is FibroScan.

FibroScan: Bringing Liver Assessment to the Community

A FibroScan is a painless, non‑invasive device that measures liver stiffness and fat content using transient elastography. For people who use drugs, especially those with risk factors such as alcohol use or past hepatitis C infection, a FibroScan can identify early fibrosis or cirrhosis long before symptoms arise.

FibroScan is widely recognised within hepatology as the standard non‑invasive method for assessing fibrosis and is routinely used within liver pathways overseen by ODNs.

Given the existing delivery models in community drug and alcohol treatment services, such as outreach vans, peer‑supported testing, and opt‑out testing pathways within community settings, FibroScan fits naturally as an extension of these approaches. In fact, some services are already effectively using FibroScans in their everyday delivery. One example of this is Inclusion One Recovery Buckinghamshire (part of Midlands Partnership University NHS Foundation Trust). You can listen to the podcast here: FibroScan Podcast

Bringing FibroScan into community drug and alcohol treatment settings allows for:

The early identification of liver disease among people who have high risks of liver disease
The delivery of immediate harm‑reduction advice based on results
Rapid referral into hepatology for people with significant fibrosis
A visible, engaging method to discuss liver health with people accessing the community drug and alcohol treatment service.
The continuation of a familiar test, treat and support model

Critically, FibroScan results are instantly available, which suits the flexible, opportunistic nature of community engagement, and is also essential for people who may not return for follow‑up appointments.

Building on Micro‑Elimination Success to Deliver Holistic Care

England’s micro‑elimination efforts in community drug and alcohol treatment settings show how powerful targeted interventions can be. At the time of writing, 30 services within the NHS Addictions Provider Alliance have already achieved hepatitis C micro‑elimination, supported by the Hep C U Later programme (About us – HEP C U Later)

This level of coordinated, high‑impact activity demonstrates that:

Community drug and alcohol treatment services can run systematic screening programmes.
Peer involvement drives uptake.
Stigma‑reducing approaches are essential.
Strong coordination with ODNs guarantees treatment progression.
Outreach and innovative delivery reach people who typically disengage from healthcare for a variety of reasons.

These same principles are perfectly suited to a national liver health strategy within drug and alcohol services. Many of the risk factors for hepatitis C coincide with risk factors for liver disease more generally, meaning that the same population can benefit enormously from expanded screening.

Wider Physical Health Interventions: A Natural Extension

Beyond liver health, community drug and alcohol treatment services are ideally placed, with the right resource and input, to deliver:

Vaccinations (hepatitis A and B, flu, COVID‑19, pneumonia)
COPD screening for individuals who smoke or vape
Wound care and skin infection management
Sexual and reproductive health interventions
Cardiovascular health interventions (BP checks, lifestyle interventions)

The hepatitis C elimination programme already demonstrated that such services can be integrated into existing workflows while improving engagement, outcomes, and trust.

Overcoming Barriers and Looking Ahead

While the opportunity is significant, challenges remain:

Workforce capacity and funding stability
Need for commissioning models that recognise the physical‑health role of community drug and alcohol treatment services
Ensuring links to primary care and hepatology are strong and consistent
Managing increasing clinical complexity in community settings
Avoiding over‑medicalisation while maintaining a harm‑reduction ethos

Fortunately, the established governance and partnership structures of the hepatitis C elimination programme, through ODNs, integrated care boards, and joint work with voluntary sector partners, and many more, provide a strong template for scaling up.

Conclusion

The success of England’s hepatitis C elimination efforts has reshaped what community drug and alcohol treatment services can achieve. By becoming a trusted point of care for populations poorly served by traditional healthcare models, these services have built a platform capable of delivering broader physical health interventions that save lives, reduce health inequalities, and prevent long‑term complications.

Expanding liver health screening—especially through the use of FibroScans, represents one of the most impactful next steps. Combined with wider preventative and diagnostic activities, community drug and alcohol treatment services can play a transformative role in meeting the physical health needs of people who are often marginalised and experience persistent barriers to care.