ABSTRACT
Background: Many services including those related to hepatitis C virus (HCV) care were disrupted during the COVID-19 pandemic. We assessed the impact of the COVID-19 pandemic on the HCV care cascade in Rwanda. Methods: This study used data from the Rwanda Health Management Information System. We included data for all individuals who received HCV services from screening to treatment and cure [sustained virological response at week 12 (SVR12)], from July 2019 to June 2020. We defined HCV care cascade as: 1) HCV antibody (Ab) positive, 2) HCV RNA tested, 3) HCV RNA detectable, 4) patients eligible for treatment, 5) patients on treatment, 6) assessed for SVR12, 7) achieved SVR12. Results: Between July 2019 and June 2020, 1,909,450 persons were screened for HCV in Rwanda (95,899 screened from July to December 2019, and 1,813,551 from January to June 2020). From January 2020, HCV elimination plan was implemented, with an increased allocation of resources for HCV-related services. Overall, 60,961 people (3.19%) were screened positive for HCV-Ab, the highest prevalence in November 2019 (11.9%), and the lowest in June 2020 (1.47%). Among those who were HCVAb positive, 31.33% (47.54% in 2019 vs 29.1% in 2020) were tested for HCV RNA, and 77.63% of those had a detectable viral load (77.63% in both 2019 and 2020). Of 25,056 people eligible for HCV treatment (people over 17 years old, nonpregnant or breastfeeding women, patients without HCC), 69.76% started treatment (95.14% in 2019 vs 52.15% in 2020). Among 6,714 who completed HCV treatment, 50.59% (22.34% in 2019 vs 74.49% in 2020) were assessed for SVR12. From July 2019 to June 2020, the number of people screened for HCV-Ab increased, while the proportion of patients tested for HCV RNA among those who were HCVAb positive decreased from October 2019. Conclusion: The number of people screened and treated for HCV increased in Rwanda during the study period. Overall, more people were screened during the period of early 2020 compared to the later part of 2019, suggesting that the COVID-19 pandemic did not disrupt screening. However, the proportion of patients who received subsequent services in the HCV care cascade are still low and decreased in 2020 compared to 2019, which is likely due to the impact of the COVID-19 pandemic. There is a need to plan the re-engagement of individuals who may have experienced delays in hepatitis care during the COVID-19 pandemic in order to achieve the hepatitis elimination goals. .
ABSTRACT
Context: Hepatic manifestations of Coronavirus Disease 2019 (COVID-19) are common among people living with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Objectives: This systematic review aimed to summarize the evidence on COVID-19 patients living with HBV or HCV co-infections. Data Sources: We searched multiple electronic databases and preprint servers from December 1, 2019, to August 9, 2020. Study Selection: Studies were included if they reported quantitative empirical data on COVID-19 patients living with HBV or HCV co-infections. Data Extraction: Descriptive analyses were reported, and data were synthesized narratively. The quality assessment was completed using the Joanna Briggs Institute critical appraisal tools. Results: Out of the 941 uniquely identified records, 27 studies were included. Of the eligible studies, 232 COVID-19 patients were living with HBV and 22 were living with HCV. Most patients were male, and the mean age was 49.8 and 62.8 years in patients living with HBV and HCV, respectively. Among the reported cases of SARS-CoV-2-HBV co-infection, the proportions of death were 4.7% and 15% in cross-sectional and case series/report studies, respectively. The death proportion was 8.3% among the reported cases of SARS-CoV2-HCV co-infection. Among COVID-19 patients, 34.1% and 76.2% reported at least one comorbidity besides HBV and HCV infections, mainly hypertension and type 2 diabetes mellitus. The most common COVID-19-related symptoms in both HBV and HCV groups were fever, cough, dyspnea, fatigue, and gastrointestinal symptoms. Conclusions: While understanding the pathogenesis of SARS-CoV-2 requires further investigations, the careful assessment of hepatic manifestations and chronic infections, such as HBV and HCV upon the admission of COVID-19 patients could help reduce multimorbidity among HBV or HCV patients and lead to more favorable health outcomes among them.