A new modelling study suggests Scotland is nearing the World Health Organization’s hepatitis C virus (HCV) elimination target, driven by a pronounced decline in HCV incidence among people who inject drugs (PWID). The research, based on long-term data from more than 11,600 PWID across five national bio-behavioral survey rounds between 2013 and 2023, used a Bayesian framework to estimate and compare new HCV infections over time. The analysis shows substantial reductions in both primary infections and reinfections, signaling meaningful population-level impact.
Steep Declines Since 2015
By the 2022–23 period, 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% decrease results from a 40% fall in primary infections and a 78% drop in reinfections. The trajectory places Scotland within striking distance of the WHO elimination benchmark of two new infections per 100 person-years.
Impact of Expanded Treatment Access
The modelling window aligns with Scotland’s rollout of direct-acting antiviral (DAA) therapy, which has transformed HCV management through short, highly effective, and well-tolerated oral regimens. The observed reduction in reinfection rates underscores the value of DAA treatment, complemented by ongoing harm-reduction strategies such as needle-exchange programs and opioid substitution therapy.
Policy implications and future needs
Researchers caution that continued progress will depend on maintaining high treatment uptake and comprehensive prevention coverage. The findings nonetheless provide robust evidence that integrated national strategies—encompassing testing, treatment, and harm reduction—can substantially reduce transmission among high-risk groups.
If current trends persist, Scotland could become one of the first countries to achieve the WHO target for HCV incidence reduction among PWID, marking a notable milestone in global hepatitis elimination efforts.
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