Hepatitis C testing and treatment initiations in the United
States dropped by 30% at the beginning of the COVID-19 pandemic in 2020 and
treatment initiations did not recover to previous levels during 2020, an analysis
of testing and treatment data published in the journal Clinical Infectious
Modelling based on these findings, presented last month at
the 2022 Conference on Retroviruses and Opportunistic Infections, indicates
that if the reduction in treatment initiation was sustained for at least two
years, the number of deaths due to hepatitis C would be almost twice as high than
if the reduction in treatment initiation only lasted one year.
The University of California San Diego research group who
published the study say that the United States will fall even further behind on
hepatitis C elimination goals as a result of COVID-19, so that intensified
efforts will be needed to screen and diagnose hepatitis C and link people to
The UCSD researchers assessed hepatitis C testing and
treatment activity in the United States from a national database that integrates
data on laboratory testing and prescriptions.
The researchers compared the numbers of HCV antibody tests,
RNA tests, genotype tests and treatment initiations between the period January
2019 and March 2020 (pre-COVID) and the period April 2020 and December 2020 (COVID-19 pandemic).
These data were used to estimate tests and treatment starts for each state, as
well as by age. Sub-analyses were carried out for four large states (New York,
California, Illinois and Florida) to assess the impact of the timing of
shutdowns on hepatitis C testing rates.
At the beginning of the pre-COVID period, 806,774 hepatitis
C antibody tests were carried out in January 2019. Antibody test numbers fell by
0.8% per month up to March 2020 and then dropped by 37% (-238,473 tests) from March
to April 2020. Test numbers rebounded to pre-COVID levels by the end of 2020.
The decline in antibody testing tracked the 42% fall in
emergency room visits between early March and April 2020, the researchers note.
Hepatitis C treatment initiations fell by 31% during the
early months of the pandemic but did not recover to pre-COVID levels by the end
of 2020. The researchers note that the time between diagnosis and linkage to
care doubled among people diagnosed with hepatitis C at the UCSD emergency
department, suggesting that hesitancy to engage with health services may
explain the lower treatment initiation rate. The timing and extent of lockdown
did not affect the rate of treatment initiation.
The San Diego group also developed a mathematical model that
simulated the impact of varying durations of suppressed treatment initiation on
HCV-related mortality and on the incidence of new infections. The model assumed
that 2.4 million had chronic hepatitis C in 2015, that just under half were
aware of their infection by 2014 and that 44% of people who inject drugs had
hepatitis C in 2018.
They modelled three scenarios: no change in treatment uptake,
a 30% reduction in uptake lasting one year or a 30% reduction in uptake lasting
Hepatitis C incidence among people who inject drugs would
increase slightly under the two-year disruption scenario, although the impact
of this increase on achievement of the HCV elimination target of an 80%
reduction in incidence by 2030 would be marginal. The model shows that under
all scenarios, HCV incidence will decline by approximately 5% between 2015 and
2030, far short of the target.
Mortality due to hepatitis C would be greater in the case of
a two-year disruption. The model finds that approximately 800 additional deaths
would occur as a result of a two-year disruption compared to a one-year disruption
and overall, a two-year disruption would lead to a 20% reduction mortality by