ABSTRACT
Background: COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden The objective of this analysis was to evaluate the incremental change in hepatitis C liverrelated deaths and liver cancer, following a 3-month, 6-month, or 1-year hiatus in hepatitis elimination program progress Methods: Previously developed models were adapted for 110 countries to include a status quo or “no delay” scenario and a “1-year delay” scenario assuming significant disruption in interventions (screening, diagnosis and treatment) in the year 2020 Annual, country-level, model outcomes were extracted, and weighted averages were used to calculate regional (WHO and World Bank Income Group) and global estimates from 2020 to 2030 The incremental annual change in outcomes was calculated by subtracting the “no-delay” estimates from the “1-year delay” estimates Results: The “1-year delay” scenario resulted in 44,800 (95% UI: 43,800 - 49,300) excess hepatocellular carcinoma (HCC) cases and 72,300 (95% UI: 70,600 - 79,400) excess liver-related deaths (LRDs), relative to the “no delay” scenario globally, from 2020-2030 Most missed treatments would be in lower-middle income countries, while most excess HCC and LRDs would be among high-income countries Under the “1-year delay” scenario, no regions were projected to reach the WHO targets for diagnosis, treatment or incidence, and only the highincome country group was projected to achieve the target for liver-related deaths Conclusion: The impact of COVID-19 extends beyond the direct morbidity and mortality associated with exposure and infection In order to mitigate the impact on viral hepatitis programming and reduce excess mortality from delayed treatment, policy makers should prioritize hepatitis programs as soon as it becomes safe to do so. (Table Presented).