SCOTLAND appears to be closing in on the World Health Organization’s (WHO) hepatitis C virus (HCV) elimination goal, as new modelling shows a steep drop in HCV incidence among people who inject drugs (PWID).
In one of the largest long-term studies of its kind, researchers analysed data from more than 11,600 PWID across five national bio-behavioural survey rounds conducted between 2013 and 2023. The analysis, which used a Bayesian statistical model to estimate new infections, revealed major declines in both primary and recurrent HCV infection rates.
Sharp Decline in HCV Incidence Since 2015
By 2022–23, the estimated total HCV incidence among PWID was 3.4 new infections per 100 person-years, down from 7.0 per 100 person-years in 2015–16. This 51% reduction reflects the combined fall in both primary infection and reinfection rates, which dropped by 40% and 78%, respectively.
These findings suggest that Scotland is within striking distance of the WHO elimination benchmark of two new infections per 100 person-years. The results also indicate that recent public health measures, particularly the widespread scale-up of direct-acting antiviral (DAA) therapy, are translating into measurable population-level impact.
Impact of Expanded Treatment Access
The modelling period coincided with the rollout of DAA therapy across Scotland, an intervention that has revolutionized HCV management by offering short, highly effective, and well-tolerated oral regimens. The reduction in reinfection rates underscores not only the effectiveness of these treatments but also the benefits of continued harm reduction programs, including needle exchange and opioid substitution therapy.
Researchers caution that while progress is promising, sustained treatment uptake and prevention coverage will be essential to reach and maintain WHO elimination thresholds. Nonetheless, the study provides strong evidence that national strategies integrating testing, treatment, and harm reduction can dramatically curb transmission among high-risk populations.
If trends continue, Scotland may become one of the first countries to achieve the WHO target for HCV incidence reduction among PWID, marking a significant milestone in global hepatitis elimination efforts.
Reference
McDonald SA et al. Estimating incidence rates of primary infection and reinfection with hepatitis C virus among people who inject drugs in Scotland: a model-based analysis of repeated cross-sectional survey data. Lancet Reg Health. 2025; DOI:10.1016/j.lanepe.2025.101505.
