COVID-19 has caused substantial disruption to viral
hepatitis screening and treatment, a global survey finds, but has also led to improvements
in laboratory capacity and telemedicine that will benefit future efforts to
eliminate hepatitis B and C.
The Coalition for Global Hepatitis Elimination carried out a
53-question online survey of doctors and programme managers between August and December
2020. They asked about the impact of COVID-19 on service delivery and how
respondents had participated in the COVID-19 response. They also asked about the
measures adopted to safely deliver testing and treatment services, and any perceived
benefits of the COVID-19 pandemic for hepatitis care.
One hundred and three clinicians from 44 countries responded
to the survey. Just over half were in the Americas, including 16 respondents in
the United States, 28 in Africa and 15 in the European region. Most respondents
(86%) were doctors or nurses.
Survey responses, mostly given before the second wave of hospitalisation
in the Americas, Europe and South Africa, showed that the peak of disruption to
hepatitis care had occurred between February and May 2020. Almost two-thirds of
respondents reported that over half of in-patient visits had been deferred during
that period.
More specifically, 39% of hepatitis C specialists reported a
> 50% decline in treatment numbers and 28% reported > 50% reductions in
the number of people tested for hepatitis C. Hepatitis B specialists less often
reported substantial reductions in treatment numbers.
Of those providing opioid substitution therapy, one in five
reported substantial reductions (> 50%) in the number of people accessing
opioid substitution therapy.
Programme managers reported disruption to the supply chain
for diagnostics and drugs. Twenty-seven per cent reported disruption of
hepatitis C diagnostic and drug supplies and 21% reported disruption of
hepatitis B diagnostics.
Hepatitis specialists were also diverted to COVID-19 testing
or care. Thirty-one per cent reported that at least 25% of their time had been
reallocated to COVID-19 work.
Although service levels were returning to normal by the time
of the survey, 80% said that they were still seeing fewer patients than normal.
This trend was especially pronounced in Africa. Patient reluctance to venture out
of the home and into healthcare systems was judged to be the main reason for
lower activity.
To mitigate service delivery problems caused by COVID-19,
clinicians reported an increase in the quantity of medication being dispensed
in each prescription, especially in Africa. Switching patient appointments to
telemedicine (phone or video consultations) happened more frequently in the
Americas and Europe, as did deferral of laboratory tests and imaging.
Forty-seven per cent of respondents said that increases in
laboratory capacity due to COVID-19 testing would benefit hepatitis screening, while
48% said improvements in healthcare worker training would aid hepatitis
elimination. The expanded use of telemedicine could also increase capacity.