ABSTRACT
The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection and associated (COVID-19) pandemic disrupted the healthcare systems of most countries because of the overwhelming demand for COVID-19 care and the ensuing diversion of resources and public attention to this purpose. The WHO goals for HBV and HCV elimination are thus facing major hurdles regarding both screening and treatment, and are at risk of failure. Because of the pandemic, hospital liver care departments have reallocated health professionals and reduced or suspended outpatient care. Hepatitis elimination programs and interventions (screening, diagnosis, and treatment) have been reduced or halted altogether. The Egyptian Liver Research Institute and Hospital (ELRIAH) reported a reduction during 2020 vs. 2019 of 57.0% for HCV consultations and 87.2% for new referrals. In addition, Requests for HCV RNA testing were greatly affected, with 60.7% reduction in HCV RNA test requests between 2019 and 2020 with a drop of 86.9% in the number of HCV RNA-positive patients detected. In terms of HCV treatment rates;86.2% fewer patients with HCV started on antiviral treatment during the pandemic period compared to the year before. Regarding HBV, the reduction between 2019 and 2020 was 43.7% for consultations and 7.3% for new referrals. As a consequence, the number of HBsAg-positive individuals observed in ELRIAH decreased by 8.7%. Also, the requests for HBV testing were found to be highly affected. Consequently, the number of patients with detectable HBV DNA dropped by 8.3% and HBV treatment rates also decreased. In conclusion, the COVID-19 pandemic has had a significant impact on every step of the viral hepatitis cascade of care. Furthermore, HCC surveillance programmes are mostly halted.
ABSTRACT
Background: Achievement of WHO goals for HCV elimination needs scaling up of diagnosis and treatment capacities in low-income and middle-income countries, where HCV is highly endemic. However, in these regions, access to HCV diagnostic tools is severely limited. The current diagnostic algorithm is based on using two steps;rapid diagnostic test (RDTs) and viral load confirmation. So there is a need for simple point of care (POC) test that can be done in the field. Recently, we developed a novel technology for extraction and enrichment of HCV antigen using temperature-sensitive Smart Polymer, which used previously For enabling affinity enrichment of current coronavirus (SARS-CoV- 2) to improve its diagnostic sensitivity Our aim is to design a novel method for extraction and enrichment of HCV antigen using temperature-responsive smart polymer 'NIPAAm-co- HIPAAm- co- SAKIPAAm' (Patent: 2019/2002) for enabling affinity enrichment of HCV antigen to be used as a part of POC test to improve the cascade of care Methods: We used temperature-responsive smart polymer 'NIPAAm-co- HIPAAm- co- SAKIPAAm' (Patent: 2019/2002) for extraction and enrichment HCV antigen for 15 positive HCV serum samples and 5 negative HCV serum samples confirmed by PCR technique. After extraction and enrichment of HCV antigen by temperature-responsive smart polymer 'NIPAAm-co- HIPAAm- co- SAKIPAAm' samples undergo amplification and detection by thermal cycler as amplification and detection of Rt-PCR technique (SLAN-96P Real-Time PCR System ). Result(s): . The time needed for extraction and enrichment of HCV Antigen using temperature-sensitive smart polymer (10mins) which is shorter than extraction time in RT-PCR ( One hour). The results showed that HCV antigen extracted and enriched by temperature-responsive smart polymer gave the same results with positive and negative HCV samples detected by PCR, Sensitivity 100%, Specificity 100% Conclusion(s): The novel temperature-responsive smart polymer 'NIPAAm-co- HIPAAm- co- SAKIPAAm' (Patent: 2019/2002) is able to extract and enrich HCV antigen in the same sensitivity and specificity like the current PCR. The time needed for this simple technique may make it be suitable to be a part of POC test for rapid, affordable, easy-to- use test in comparison to PCR technique which needs dedicated facilities and highly qualified personnel.