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Decreases in Hepatitis C Testing
and Treatment During the COVID-19 Pandemic
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May 10, 2021 AJPM
Harvey W. Kaufman, MD,1 Lara Bull-Otterson, PhD,2 William A. Meyer III, PhD,1
Xiaohua Huang, MS,1 Mona Doshani, MD,3 William W. Thompson, PhD,3 Ademola Osinubi, MS,3 Mohammed A. Khan, PhD,3 Aaron M. Harris, MD,3 Neil Gupta, MD, MPH,3 Michelle Van Handel, MPH,3 Carolyn Wester, MD, MPH,3 Jonathan Mermin, MD, MPH,3
Noele P. Nelson, MD, PhD, MPH3
From the 1Quest Diagnostics, Secaucus, New Jersey; 2Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; and 3National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
Compared with the 2018 and 2019 months, hepatitis C virus antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July 2020. The number of hepatitis C virus RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. For hepatitis C virus treatment, prescriptions decreased 43% in May, 37% in June, and 38% in July relative to the corresponding months in 2018 and 2019.
In response to increasing rates of acute HCV infection among young adults, including reproductive-aged people, the U.S. Preventive Services Task Force recommends laboratory screening for HCV in adults, aged 18-79 years as well as women during pregnancy.4 The CDC also recommends hepatitis C testing at least once per lifetime for all adults aged 18 years and over, and for all pregnant women during each pregnancy......."This analysis adds to other studies that demonstrate that lack of access to testing and care in 2020 during the height of the pandemic means many individuals did not receive important diagnostic test and screenings, said Harvey W. Kaufman, M.D., Senior Medical Director, Head of the Health Trends Research Program for Quest Diagnostics, and the report's lead author. "It's important we communicate the need to bring Hepatitis C virus testing and treatment above pre-pandemic levels to identify people who have delayed or skipped healthcare services. Fortunately, HCV infection is now a curable condition and taking an HCV antibody screening test is the first step.” Quest press release
Introduction
The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed hepatitis C virus during the pandemic may later become identified at more advanced stages of the disease, leading to higher morbidity and mortality rates. Further, unidentified hepatitis C virus-infected individuals may continue to unknowingly transmit the virus to others.
Methods
To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and from national estimates of dispensed prescriptions for hepatitis C virus treatment. Investigators estimated the average number of hepatitis C virus antibody tests, hepatitis C virus antibody-positive test results, and hepatitis C virus RNA-positive test results by month in January-July for 2018 and 2019, compared with the same months in 2020. To assess the impact of hepatitis C virus treatment, dispensed hepatitis C virus direct-acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models.
Results
Compared with the 2018 and 2019 months, hepatitis C virus antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July 2020. The number of hepatitis C virus RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. For hepatitis C virus treatment, prescriptions decreased 43% in May, 37% in June, and 38% in July relative to the corresponding months in 2018 and 2019.
Conclusions
During the COVID-19 pandemic, continued public health messaging, interventions and outreach programs to restore hepatitis C virus testing and treatment to prepandemic levels, and maintenance of public health efforts to eliminate hepatitis C infections remain important.
INTRODUCTION
Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the U.S. and is a leading cause of liver-related morbidity and mortality.
An estimated 2.4 million adults are living with HCV infection in the U.S., and hepatitis C was reported as the underlying or contributing cause for 15,713 deaths in 2018.
Approximately 70% of adults with acute HCV develop chronic HCV infection, and if untreated, 1 in 4 of these individuals will die prematurely from HCV-associated complications, such as liver failure and hepatocellular carcinoma.
During 2015-2018, only 61% (95% CI=46, 74) of people diagnosed with hepatitis C reported having ever been told they were infected, suggesting a gap in care.
Healthcare screenings are essential for early identification of disease before severe morbidity or mortality occur. Hepatitis C testing is the first step in linking people with HCV infection to care and curative treatment. In 2012, the Centers for Disease Control and Prevention (CDC) recommended a 1-time HCV antibody test for all individuals born during 1945-1965 (baby boomers).
In 2013, the U.S. Preventive Services Task Force followed with recommendations for hepatitis C testing of those at high risk for infection, such as injection drug users, and a 1-time test for all adults born during 1945-1965.
More recently, in response to increasing rates of acute HCV among young adults, including reproductive-aged people, the U.S. Preventive Services Task Force recommends screening for HCV infection in adults (including pregnant women) aged 18-79 years, and CDC recommends hepatitis C testing at least once per lifetime, in settings with a prevalence of HCV infection ≥0.1%, for all adults aged ≥18 years and for all pregnant women during each pregnancy.
Fortunately, an effective and curative treatment is available.
Direct-acting antiretroviral (DAA) therapies, first introduced in 2013, have improved hepatitis C treatment success and reduced adverse drug events relative to interferon therapies.
Improvements have also been observed in the cascade of care among patients when restrictions to effective pharmaceuticals based on risk behavioral profiles have been removed. As a result, WHO established ambitious targets for hepatitis C elimination by 2030.
During 2020, the coronavirus disease 2019 (COVID-19) pandemic has impacted the practice of medicine.
CDC released guidance on delaying nonessential procedures and postponing routine clinical visits as part of initial mitigation strategies for the COVID-19 pandemic.
As part of this guidance, patients have been advised to utilize telemedicine, patient portals, phone, and e-mail for communication with their healthcare provider and to limit in-person visits.
Deferral of healthcare services during the pandemic may lead to delays in diagnosis and treatment, leaving people living with hepatitis C unaware of their disease status and vulnerable to progression to advanced liver disease, including cirrhosis and hepatocellular carcinoma, as well as potential spread of the virus.
Changes are examined in provided healthcare services during the COVID-19 pandemic relative to prior years with a focus on HCV antibody testing and positivity, HCV RNA positivity, and hepatitis C drug treatment prescriptions.
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