Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination

Norah E. Palmateer; Pantelis Samartsidis; Christopher Biggam; Andrew McAuley; Scott A McDonald; John Dillon; Stephen T. Barclay; Samantha J. Shepherd; Rory N. Gunson; Monica Desai; Duncan McCormick; Daniela De Angelis; Matthew Hickman; Sharon J. Hutchinson

doi:10.1111/liv.70771

Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination

Norah E. Palmateer (Lead / Corresponding author)
, Pantelis Samartsidis
, Christopher Biggam
, Andrew McAuley
, Scott A McDonald
, John Dillon
, Stephen T. Barclay
, Samantha J. Shepherd
, Rory N. Gunson
, Monica Desai
, Duncan McCormick
, Daniela De Angelis
, Matthew Hickman
, Sharon J. Hutchinson

Respiratory Medicine and Gastroenterology

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: Expansion of highly effective direct-acting antiviral (DAA) treatment for people who inject drugs (PWID) is regarded as essential to achieve hepatitis C virus (HCV) elimination. A decade since the introduction of DAA treatment, we aimed to assess its roll-out and associated impact in reducing HCV prevalence among PWID in Scotland, as part of a treatment-as-prevention (TasP) strategy.

METHODS: National bio-behavioural surveys of PWID (recruited at services providing injecting equipment) between 2010 and 2023 (N = 16 973), involving a questionnaire and blood spot sample (tested for HCV-antibodies and HCV-RNA), were used to examine treatment uptake and HCV viraemia prevalence (overall and among those with antibodies) for Tayside, Greater Glasgow & Clyde (GGC), and Rest of Scotland (RoS). We used a flexible Bayesian logistic regression model to estimate HCV prevalence and probability of having achieved an 80% reduction in HCV prevalence since 2015.

RESULTS: Between 2015-16 and 2022-23, uptake of DAAs (ever) increased 2.7-, 5.6- and 4.5-fold to 95%, 78% and 76% in Tayside, GGC and RoS, respectively. Over this period, observed viraemia prevalence declined to 4%, 16% and 15% (involving 86%, 65% and 53% decline) in Tayside, GGC and RoS, respectively. In Tayside, modelled viraemia prevalence among those with antibodies declined from 62% in 2015 to 11% in 2023, with a 53% probability that the WHO proxy target of an 80% reduction in HCV prevalence was met.

CONCLUSION: Our study provides real-world evidence for TasP, demonstrating that HCV elimination among PWID is feasible through community-wide scale-up of DAAs and population-level monitoring surveys.

Original language	English
Article number	e70771
Number of pages	12
Journal	Liver International
Volume	46
Issue number	8
Early online date	26 Jun 2026
DOIs	https://doi.org/10.1111/liv.70771
Publication status	E-pub ahead of print - 26 Jun 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Humans
Scotland/epidemiology
Antiviral Agents/therapeutic use
Substance Abuse, Intravenous/complications
Prevalence
Hepatitis C/epidemiology
Female
Male
Hepacivirus
Adult
Hepatitis C Antibodies/blood
Bayes Theorem
Logistic Models
Middle Aged
RNA, Viral/blood

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10.1111/liv.70771Licence: CC BY

Final Published VersionFinal published version, 624 KBLicence: CC BY

Cite this

Palmateer, N. E., Samartsidis, P., Biggam, C., McAuley, A., McDonald, S. A., Dillon, J., Barclay, S. T., Shepherd, S. J., Gunson, R. N., Desai, M., McCormick, D., De Angelis, D., Hickman, M., & Hutchinson, S. J. (2026). Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination. Liver International, 46(8), Article e70771. Advance online publication. https://doi.org/10.1111/liv.70771

@article{e42177a596ae45088997588b259779a7,

title = "Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination",

abstract = "BACKGROUND: Expansion of highly effective direct-acting antiviral (DAA) treatment for people who inject drugs (PWID) is regarded as essential to achieve hepatitis C virus (HCV) elimination. A decade since the introduction of DAA treatment, we aimed to assess its roll-out and associated impact in reducing HCV prevalence among PWID in Scotland, as part of a treatment-as-prevention (TasP) strategy.METHODS: National bio-behavioural surveys of PWID (recruited at services providing injecting equipment) between 2010 and 2023 (N = 16 973), involving a questionnaire and blood spot sample (tested for HCV-antibodies and HCV-RNA), were used to examine treatment uptake and HCV viraemia prevalence (overall and among those with antibodies) for Tayside, Greater Glasgow \& Clyde (GGC), and Rest of Scotland (RoS). We used a flexible Bayesian logistic regression model to estimate HCV prevalence and probability of having achieved an 80\% reduction in HCV prevalence since 2015.RESULTS: Between 2015-16 and 2022-23, uptake of DAAs (ever) increased 2.7-, 5.6- and 4.5-fold to 95\%, 78\% and 76\% in Tayside, GGC and RoS, respectively. Over this period, observed viraemia prevalence declined to 4\%, 16\% and 15\% (involving 86\%, 65\% and 53\% decline) in Tayside, GGC and RoS, respectively. In Tayside, modelled viraemia prevalence among those with antibodies declined from 62\% in 2015 to 11\% in 2023, with a 53\% probability that the WHO proxy target of an 80\% reduction in HCV prevalence was met.CONCLUSION: Our study provides real-world evidence for TasP, demonstrating that HCV elimination among PWID is feasible through community-wide scale-up of DAAs and population-level monitoring surveys.",

keywords = "Humans, Scotland/epidemiology, Antiviral Agents/therapeutic use, Substance Abuse, Intravenous/complications, Prevalence, Hepatitis C/epidemiology, Female, Male, Hepacivirus, Adult, Hepatitis C Antibodies/blood, Bayes Theorem, Logistic Models, Middle Aged, RNA, Viral/blood",

author = "Palmateer, \{Norah E.\} and Pantelis Samartsidis and Christopher Biggam and Andrew McAuley and McDonald, \{Scott A\} and John Dillon and Barclay, \{Stephen T.\} and Shepherd, \{Samantha J.\} and Gunson, \{Rory N.\} and Monica Desai and Duncan McCormick and \{De Angelis\}, Daniela and Matthew Hickman and Hutchinson, \{Sharon J.\}",

note = "{\textcopyright} 2026 The Author(s). Liver International published by John Wiley \& Sons Ltd.",

year = "2026",

month = jun,

day = "26",

doi = "10.1111/liv.70771",

language = "English",

volume = "46",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley-Blackwell",

number = "8",

}

Palmateer, NE, Samartsidis, P, Biggam, C, McAuley, A, McDonald, SA, Dillon, J, Barclay, ST, Shepherd, SJ, Gunson, RN, Desai, M, McCormick, D, De Angelis, D, Hickman, M & Hutchinson, SJ 2026, 'Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination', Liver International, vol. 46, no. 8, e70771. https://doi.org/10.1111/liv.70771

TY - JOUR

T1 - Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland

T2 - Regional Evidence of Hepatitis C Virus Elimination

AU - Palmateer, Norah E.

AU - Samartsidis, Pantelis

AU - Biggam, Christopher

AU - McAuley, Andrew

AU - McDonald, Scott A

AU - Dillon, John

AU - Barclay, Stephen T.

AU - Shepherd, Samantha J.

AU - Gunson, Rory N.

AU - Desai, Monica

AU - McCormick, Duncan

AU - De Angelis, Daniela

AU - Hickman, Matthew

AU - Hutchinson, Sharon J.

PY - 2026/6/26

Y1 - 2026/6/26

N2 - BACKGROUND: Expansion of highly effective direct-acting antiviral (DAA) treatment for people who inject drugs (PWID) is regarded as essential to achieve hepatitis C virus (HCV) elimination. A decade since the introduction of DAA treatment, we aimed to assess its roll-out and associated impact in reducing HCV prevalence among PWID in Scotland, as part of a treatment-as-prevention (TasP) strategy.METHODS: National bio-behavioural surveys of PWID (recruited at services providing injecting equipment) between 2010 and 2023 (N = 16 973), involving a questionnaire and blood spot sample (tested for HCV-antibodies and HCV-RNA), were used to examine treatment uptake and HCV viraemia prevalence (overall and among those with antibodies) for Tayside, Greater Glasgow & Clyde (GGC), and Rest of Scotland (RoS). We used a flexible Bayesian logistic regression model to estimate HCV prevalence and probability of having achieved an 80% reduction in HCV prevalence since 2015.RESULTS: Between 2015-16 and 2022-23, uptake of DAAs (ever) increased 2.7-, 5.6- and 4.5-fold to 95%, 78% and 76% in Tayside, GGC and RoS, respectively. Over this period, observed viraemia prevalence declined to 4%, 16% and 15% (involving 86%, 65% and 53% decline) in Tayside, GGC and RoS, respectively. In Tayside, modelled viraemia prevalence among those with antibodies declined from 62% in 2015 to 11% in 2023, with a 53% probability that the WHO proxy target of an 80% reduction in HCV prevalence was met.CONCLUSION: Our study provides real-world evidence for TasP, demonstrating that HCV elimination among PWID is feasible through community-wide scale-up of DAAs and population-level monitoring surveys.

AB - BACKGROUND: Expansion of highly effective direct-acting antiviral (DAA) treatment for people who inject drugs (PWID) is regarded as essential to achieve hepatitis C virus (HCV) elimination. A decade since the introduction of DAA treatment, we aimed to assess its roll-out and associated impact in reducing HCV prevalence among PWID in Scotland, as part of a treatment-as-prevention (TasP) strategy.METHODS: National bio-behavioural surveys of PWID (recruited at services providing injecting equipment) between 2010 and 2023 (N = 16 973), involving a questionnaire and blood spot sample (tested for HCV-antibodies and HCV-RNA), were used to examine treatment uptake and HCV viraemia prevalence (overall and among those with antibodies) for Tayside, Greater Glasgow & Clyde (GGC), and Rest of Scotland (RoS). We used a flexible Bayesian logistic regression model to estimate HCV prevalence and probability of having achieved an 80% reduction in HCV prevalence since 2015.RESULTS: Between 2015-16 and 2022-23, uptake of DAAs (ever) increased 2.7-, 5.6- and 4.5-fold to 95%, 78% and 76% in Tayside, GGC and RoS, respectively. Over this period, observed viraemia prevalence declined to 4%, 16% and 15% (involving 86%, 65% and 53% decline) in Tayside, GGC and RoS, respectively. In Tayside, modelled viraemia prevalence among those with antibodies declined from 62% in 2015 to 11% in 2023, with a 53% probability that the WHO proxy target of an 80% reduction in HCV prevalence was met.CONCLUSION: Our study provides real-world evidence for TasP, demonstrating that HCV elimination among PWID is feasible through community-wide scale-up of DAAs and population-level monitoring surveys.

KW - Humans

KW - Scotland/epidemiology

KW - Antiviral Agents/therapeutic use

KW - Substance Abuse, Intravenous/complications

KW - Prevalence

KW - Hepatitis C/epidemiology

KW - Female

KW - Male

KW - Hepacivirus

KW - Adult

KW - Hepatitis C Antibodies/blood

KW - Bayes Theorem

KW - Logistic Models

KW - Middle Aged

KW - RNA, Viral/blood

U2 - 10.1111/liv.70771

DO - 10.1111/liv.70771

M3 - Article

C2 - 42358127

SN - 1478-3223

VL - 46

JO - Liver International

JF - Liver International

IS - 8

M1 - e70771

ER -

Impact of Antiviral Therapy Scale-Up Among People Who Inject Drugs in Scotland: Regional Evidence of Hepatitis C Virus Elimination

Abstract

UN SDGs

Keywords

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