The impact of COVID-19 on the cascade of care of HCV in the u.s. and china

ABSTRACT

Introduction: The COVID-19 pandemic has dramatically imperiled the health system worldwide. It may also negatively impact the cascade of care of hepatitis C virus (HCV) infection and the progress on WHO 2030 goal of HCV elimination. In this study, we used a multinational, multicenter cohort to estimate the change in the completion of DAA therapy, HCV RNA testing, and clinical encounter during pandemic. Methods: We collected data patients who underwent DAA therapy at three tertiary medical centers in Los Angeles (US), Xi'an (China), and Nanjing (China) between January 1, 2019 to June 30, 2020 and followed until November 30, 2020. We compared the proportions of HCV patients who completed DAA therapy as well as had HCV RNA testing and follow-up visits during and after the end of the HCV therapy between COVID-19 pandemic and the periods before pandemic. Additionally, we determined the frequency and predictive factors of utilization of telemedicine. Results: A total of 256 patients with HCV infection were included. Despite no significant reduction in the completion of DAA before and during the pandemic, the proportion of patients undergoing HCV RNA testing during DAA treatment decreased from about 80% before pandemic to 67% during the pandemic, with a more prominent decrease in the US. There were less than 10% of patients who had HCV RNA testing 12 weeks post-treatment during COVID-19 era. Compared to pre-pandemic period, post-treatment clinic encounter decreased significant in China but elevated in the US. Further analysis showed that the increase was due to the surge in utilization of telemedicine. However, the increased number of follow-up visits during COVID-19 pandemic period did not result in an increase in HCV RNA testing. Conclusion: COVID-19 pandemic carried profound impact on the cascade of care for HCV patients in both the US and China. Despite the increased use of telemedicine in the US, the adherence to recommendations for HCV RNA testing was still disappointingly low. Stakeholders should identify the modifiable barriers and reinforce the care while withstanding the pandemic.