What does hepatitis C micro-elimination in drug services mean?

What is the micro-elimination criteria?

Hepatitis C micro-elimination in a drug service means the service have achieved

1. 100% of people who access the service have been offered a test
2. 100% of people who access the service with a history of injecting drugs have had a test
3. 90% of people in structured treatment with a history of injecting drugs who are at risk have had a test in the last 12 months
4. 90% of people have started treatment, completed treatment, or cleared the virus naturally

There are a number of additional checks completed on the data in addition to looking at this criteria to ensure that data anomalies have been addressed and data quality is upheld.

What does it mean when a service has achieved micro-elimination?

Essentially the service has met these criteria, however, it does not mean that the work stops there.  The service will have to work to ensure they continue to meet the criteria.

Services who achieve micro-elimination may also want to look at how they extend testing to people not accessing their services, or by working collaboratively in their local area to extend testing.

When a service reaches micro-elimination this status is awarded for 6 months, at which point it is reviewed. However, the work continues within the service throughout this period of time to ensure the status can be upheld.  

Where does the data come from?

The data is collected from National Drug Treatment Monitoring Service (NDTMS) data which is routinely collected by drug services.  It is worth noting that data which is collected is only for those receiving structured care within drug and alcohol services, and those who have consented to allowing their data to be collected by NDTMS.

Where did the criteria come from?

The hepatitis C micro-elimination criteria came from an agreement between NHS England, The Hepatitis C Trust, the NHS Addictions Provider Alliance (14 NHS Trusts represented by Hep C U Later), and multiple third sector organisations.  All the organisations came together to form the Hepatitis C Drug Treatment Provider Forum.

The details of what data is used and how it is calculated in much more detail can be found by accessing the micro-elimination criteria document on our resources page.

Other things to consider:

It is worth noting that prison settings may have a slightly different criteria.

Some organisations which provide drug and alcohol support, and treatment may differ in how they approach meeting criteria 4.  This is due to having different systems and agreements with how this is collected.  For information on how organisations outside of the NHS Addictions Provider Alliance calculate criteria 4 please contact them.