Surveillance of hepatitis C in Scotland
Progress on elimination of hepatitis C as a major public health concern: 2025 update

About this release

This annual release follows the HCV surveillance report published in January 2025 and includes the most up-to-date surveillance data through December 2024, except for data from the HCV clinical database, which is reported by financial year up to the end of March 2025. The report outlines Scotland’s progress toward achieving both national and World Health Organization (WHO) hepatitis C elimination targets described in the Background section below.

Main points

Progress against targets

Following the national Action Plan, the framework for assessing progress toward hepatitis C elimination targets was outlined in the Data Monitoring Plan published by Public Health Scotland in June 2025. Public health surveillance data, presented here, indicate that Scotland continues to make major progress toward several WHO hepatitis C elimination targets, as well as the programmatic targets that facilitate elimination, demonstrating sustained reductions in HCV-related mortality alongside substantial improvements in treatment uptake and harm reduction coverage:

• In 2024, hepatitis C–related mortality in Scotland continued to meet the WHO threshold of ≤2 deaths per 100,000 population, with 0.97 deaths per 100,000 among those ever chronically infected and 0.25 per 100,000 among those currently chronically infected.
• By March 2025, the vast majority (85%) of individuals last known to have chronic HCV infection, had been successfully treated and cleared of HCV infection. This represents evidence to indicate Scotland continues to achieve the WHO target to treat 80% of those diagnosed (first reported in 2022).
• Coverage of opioid agonist therapy (OAT) among people who inject opioids remains high - approximately 76% in 2024 - well above the WHO target of 40%. Provision of needles and syringes for people who inject drugs (PWID) exceeds the 2025 WHO target of 200, with a median of 260 items distributed per person annually in 2022/23.

Substantial progress has been made toward hepatitis C elimination, but certain gaps remain that must be addressed to ensure continued advancement and the achievement of key WHO and Scottish Government (SG) targets:

• Considerable progress was recorded toward achieving the SG goal of fewer than 10 new decompensated cirrhosis (DC)/hepatocellular carcinoma (HCC) admissions or deaths among individuals with chronic HCV at the time of admission or death by 2024/25 (14 deaths, 20 new DC admissions, 10 new HCC admissions), though the target remains to be fully achieved.
• The estimated incidence of HCV infection (expressed as new infections per 100 person-years among the population at risk) has reduced to 3.4/100 by 2022/23, consistent with 59% decline in chronic HCV prevalence among PWID since 2015. However, this still falls short of the WHO targets of incidence of ≤2 per 100 person-years incidence and 80% prevalence reduction.
• The proportion of infected individuals (with a drug use history) diagnosed is approaching the WHO 2030 target of 90%, with evidence to indicate that 84% of people who have had chronic infection have been diagnosed as of March 2024. Among PWID, the proportion of those aware of their current or past infection remains lower at 74%, as of 2022/23.
• In 2024, 148,339 individuals were tested for HCV antibody and/or PCR - the highest annual total in a decade. Despite this, testing coverage in key settings and populations (prisons and people receiving OAT) remains low, with only 18% of prison admissions tested within six weeks and 38% of people on OAT tested in the last year. Testing targets were not in place in 2024, but the low uptake rates from 2023 informed new targets commencing in 2025.
• In 2024, 1,351 new HCV antibody-positive cases were diagnosed, similar to the overall number in 2023 after a sharp rise was observed from the previous year. This levelling off despite record testing levels emphasises the need to increase test uptake in key settings and populations.
• In 2024/25, 1,352 individuals commenced HCV treatment, falling short of the SG’s minimum national target of 2,500. The minimum national treatment targets for 2025/26 were reduced to 1,750 initiations.

Delivery strategy

To ensure continued progress toward hepatitis C elimination it is necessary to sustain the current achievement of WHO targets for: reduced mortality; a high proportion of individuals previously diagnosed with chronic HCV who have been successfully treated and cured; and high coverage of OAT among people who inject drugs.

It is also necessary to make further progress on: reducing new DC/HCC admissions and deaths among individuals with chronic HCV; preventing new infections; increasing testing and diagnosis among people in prisons and individuals with a history of drug use; and expand the number of people commencing HCV treatment.

The Scottish Health Protection Network supports national and local partners in achieving this progress. Current strategies include:

• Integration and alignment of a range of actions aimed at elimination and transmission elimination of all three blood borne viruses - HCV, HIV and HBV. For example, work to achieve HCV testing targets should include testing for HCV, HBV and HIV.
• Prioritisation of surveillance of HCV reinfections to enable effective outbreak management and ongoing elimination efforts. This is particularly important in settings and population groups where the risk of transmission and reinfection is high. Surveillance data needs to be supplemented with improved knowledge on why people become re infected and how to prevent it.
• Maintenance of systematic monitoring and use of evidence-based data to assess advancement toward the established targets. This can be achieved through:
  • Strengthening the monitoring of progress using linked data sources;
  • Securing continued funding for bio-behavioural (‘NESI’) surveillance initiatives and modelling studies to ensure accurate and up-to-date estimates;
  • Maintaining regular auditing and validation of national data in collaboration with NHS Boards as part of ‘RECAST’; and
  • Ensuring that the right data is accessed in a useable form by the wide range of partners crucial to success.

Background

On 31 July 2019, the SG committed to eliminate hepatitis C virus (HCV) as a major public health concern by 2024, with a recently revised target to achieve elimination by the end of 2024/25 financial year. Prior to that, the WHO had set global targets in 2016 for the elimination of HCV as a public health threat. These initially included reducing new infections in the general population by 80% and HCV-related mortality by 65% by 2030, along with facilitating targets such as diagnosing 90% of those infected and treating 80% of those diagnosed. WHO introduced further complementary hepatitis C elimination targets, setting an annual incidence threshold of ≤2 per 100 PWID and an annual mortality threshold of ≤2 deaths per 100,000. In 2022, the WHO introduced harm reduction indicators to support hepatitis C elimination efforts, targeting distribution of ≥200 sterile needles/syringes per PWID annually by 2025 and ≥300 by 2030, and ≥40% OAT coverage among PWID.

The vision for Scotland was to not only achieve these WHO targets in advance of 2030, but also to commit to additional national targets on reducing:

• the number of people living with chronic HCV infection to 5,000 or fewer, and
• the number of people developing or dying from HCV-related severe disease to fewer than 10 new presentations or deaths per year for each of the following outcomes: DC, HCC, and death due to DC and/or HCC among people with chronic HCV infection at the time of presentation or death.

Complementing these goals, SG established a set of operational targets designed to facilitate elimination, measured through service delivery and coverage indicators. These include annual national and local targets for

• HCV treatment initiates;
• the proportion of OAT clients tested in Alcohol and Drug Recovery Services (ADRS);
• the proportion of individuals tested within six weeks of prison entry.

In 2025, new thresholds for treatment targets for 2025/26 were established by SG alongside, for the first time, thresholds for testing targets in key settings and populations.

Further information

The next release of this publication will be in 2026/27 date to be confirmed.