The COVID-19 pandemic severely reduced hepatitis C testing, diagnosis
and treatment in the United States during 2020, a study by Quest Diagnostics
and the US Centers for Disease Control and Prevention (CDC) reports.
The findings are published in the American Journal of Preventive
An estimated 2.4 million adults are living with hepatitis C
in the United States, but a large proportion remain undiagnosed and unable to
benefit from curative treatment with direct-acting antivirals.
CDC recommends that all
adults born between 1945 and 1965 – the baby boom generation – should be tested
at least once for hepatitis C. The US Preventive Services Taskforce
subsequently recommended that all adults aged 18-79 years should be screened
for hepatitis C.
The COVID-19 pandemic has affected uptake of numerous
healthcare interventions, especially screening and non-urgent monitoring.
Avoidance of clinical visits due to COVID-19 reduces opportunities to offer
screening, but it is unclear how much hepatitis C testing and treatment has
been affected by the pandemic.
To investigate screening and treatment initiation during
2020, a large diagnostic laboratory and the CDC compared hepatitis C antibody and RNA testing and direct-acting antiviral
prescriptions from March to July 2020 with the same periods in 2018 and 2019.
Prescription data were obtained from a database covering 92% of outpatient
prescriptions and 78% of mail order prescriptions in the United States.
A total of 5,587,943 HCV antibody tests were recorded in the
Antibody tests began to fall sharply from mid-March 2020.
Measured week-on-week, testing activity had fallen by 65% by the second week of
April 2020 compared to the same week in 2018 and 2019. An average of 413,641
tests were carried out in April 2018 and 2019, compared to 168,126 in April
Testing activity recovered gradually so that by July 2020,
it was around 6% lower than the corresponding weeks in 2018 and 2019.
Positive diagnoses also fell by 56% in April 2020 as did
positive HCV RNA results indicating chronic HCV infection (down 62% in April
2020). Positive HCV RNA tests remained 39% lower in July 2020 than the average
for 2018 and 2019. Prescriptions for direct-acting antivirals were 38% lower in
July 2020 compared with 2018 and 2019.
When analysed by age, testing and prescribing activity
suggested that older people were avoiding face-to-face clinical encounters,
reducing opportunities for hepatitis C diagnosis. In 2018, approximately two-thirds of tests
were carried out in people aged 40 or over; in 2020, 52% of tests were carried
out in the over-40s.
Dispensing of direct-acting antivirals – a 12-week or 8-week
treatment course in most cases – fell in people aged 60-84 in 2020. The 60-84
age group accounted for 45% of prescriptions in 2018 and 37% of prescriptions
in 2020. Prescriptions to people aged 20-39 years increased from 14% of all
prescriptions in 2018 to 24% of all prescriptions in 2020.
The shift towards prescribing more treatment courses to
younger people may not be a consequence of COVID-19 alone, the study authors
say. Greater awareness of risk factors for hepatitis C among younger people and
the rise in opioid injecting may also explain greater testing activity and more