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Impact of the 2020 COVID-19 Pandemic
on Ambulatory Hepatitis C Testing
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Download the PDF here
November 22, 2020
The significant decrease in HCV screening reported here demonstrates the consequential tradeoffs that occur between workplace safety and preventive patient care services, as a result of health system responses during this pandemic. Like HCV, many chronic illnesses are being impacted by this pandemic. Dramatic decreases in preventive screening tests, missed prescription starts for chronic diseases due to delayed diagnosis, delayed cancer treatment, and postponement of childhood vaccinations have been noted in multiple practice environments.11-13 In light of the pandemic-related resource limitations and safety mitigation techniques, proactive healthcare models must be favored over reactive models, with interventions that reduce health risks, decrease avoidable emergency room visits, and minimize the burden of chronic disease-related complications.14
From Jules: and while many have adapted to these new conditions with new HCV models of screening & care in the USA & globally a big negative impact likely persists due to reduced HCV screening, linkage & treatment.
https://journals.sagepub.com/doi/10.1177/2150132720969554
Abstract
Introduction:
Coronavirus disease 2019 (COVID-19) has led to unprecedented modifications to healthcare delivery in the U.S. To preserve resources in preparation for a COVID-19 surge, Boston Medical Center (BMC) implemented workflows to decrease ambulatory in-person visits effective March 16th, 2020. Telemedicine was incorporated into clinical workflows and much preventive care, including Hepatitis C (HCV) testing, was not routinely performed.
Objective:
To explore the impact that the COVID-19 rapid restructuring response has had on HCV testing and identification hospital-wide and in ambulatory settings.
Methods:
BMC utilizes reflex confirmatory testing for HCV. When a sample is HCV Ab positive, it is automatically reflexed for confirmatory RNA and genotype testing. HCV test results for patients were collected daily. We compared unique patient tests for 3.5 month periods before and after March 16th, 2020. Descriptive statistics showed total tests and total new HCV RNA+ before versus after, both hospital-wide and in ambulatory clinics alone. Mean daily tests completed were compared.
Results:
Hospital-wide, total HCV testing decreased by 49.6%, and new HCV+ patient identification decreased by 42.1%. In ambulatory clinics, testing decreased by 71.9%, and new HCV+ identification decreased by 63.3%. Hospital-wide, mean daily tests decreased by 22.9 tests per day (95% CI: 17.9-28.0, P < .001), and mean daily new HCV+ identification decreased by 0.36 (95% CI: 0.20-0.53, P < .001). In ambulatory clinics, mean daily tests decreased by 22.1 tests per day (95% CI: 17.5-26.7, P < .001) and mean daily HCV+ decreased by 1.40 (95% CI: 1.03-1.76, P < .001).
Conclusion:
The COVID-19 systematic emergency response led to decreased HCV testing and identification, and in this regard telemedicine acts as a barrier to HCV care. Other public health initiatives must be monitored in the context of telemedicine workflows. Continued monitoring of HCV screening trends is vital, and adaptive approaches to work toward the goal of HCV elimination are needed.
While historical guidance from the CDC recommended one-time testing for those in the “baby boomer” birth cohort (born between 1945 and 1965) and periodic testing for those at high risk for infection, the need to further expand screening became paramount as cases in young adults continue to rise in relation to the opioid epidemic.
Healthcare providers utilizing telehealth visits should also use them as an opportunity for greater patient education and emphasize the importance of preventive care. Since telehealth visits do not negate the need for in-person healthcare visits for lab-work and vaccinations, telehealth visits can also be used to educate patients on the healthcare system safety measures that prevent the spread of COVID-19. This will serve to alleviate fears among those still hesitant to visit in-person.
Facilities should develop streamlined processes for rapid in-and-out lab and vaccination visits to supplement telehealth appointments. Non-traditional options, such as drive-through vaccination programs, street outreach coupled with telemedicine to engage people experiencing homelessness, and increased access to in-home care have been used at our institution and should be seen as best-practices to use when possible.15
The long-term impacts of these gaps in primary and preventive healthcare could be detrimental, and deliberate efforts to counteract this impact must be made. Preventive care gaps due to COVID-19 must be identified and targeted. Continued monitoring of HCV screening trends is vital, and adaptive approaches to working toward the goal of HCV elimination in the evolving virtual health world are needed.
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