LESSONS FROM HEPATITIS C TREATMENT DURING THE COVID-19 PANDEMIC: DECREASED RESOURCE UTILIZATION LEADS TO SIMILAR EFFICACY IN BRITISH COLUMBIA, CANADA

ABSTRACT

Background: Early studies show that the COVID-19 pandemic has led to reduced prescription of direct-acting anti-viral (DAA) treatment for hepatitis C (HCV) infection. We sought to characterize HCV patients started on DAAs during the pandemic in British Columbia, Canada. Methods: A retrospective chart review of multiple sites was conducted using the British Columbia HCV Network. Patients initiated on DAA for HCV treatment from 09/17/2018- 09/17/2021 were included. Those treated for 18 months prior to 03/17/2020 were included as the pre-pandemic group (pre-PG) and those treated after 03/17/2020 comprised the pandemic group (PG). Results: A total of 393 patients were included, with 221 pre-PG patients and 172 PG patients, representing a 23% decline in HCV treatment during the pandemic. PG patients were significantly younger with mean age 55 years (vs 56 years pre- PG, p<0.01) and a higher proportion were on opioid agonist therapy (OAT) at 28% (vs 12% pre-PG, p<0.01). Rates of alcohol and active substance use were similar between both groups. Both groups had similar HCV genotypes, viral load, and FIB-4 scores. Pre-treatment transient elastography (TE) within 3 months of initiating treatment was completed in significantly fewer PG patients at 37% compared with 70% pre-PG (p<0.01). Of PG and pre-PG patients who completed TE, cirrhosis was found in 15 (9%) and 32 (14%) respectively, with mean liver stiffness measure of 8.69 kPa and 10.21 kPa, respectively. Beyond less utilization of TE, the pandemic also led to reduced total appointments at mean 3.1 visits per PG patient compared to 4.2 visits per pre-PG patient (<0.01). Considering the different types of appointments, PG patients had fewer office appointments at mean 1.6 per PG patient (vs 3.1 per pre-PG patient, p <0.01) but more telehealth appointments at mean 2.5 per PG patient (vs 2.1 per pre-PG patient, p <0.01). Treatment regimen was similar in both groups with predominant use of glecaprevir/pibrentasvir and sofosbuvir/velpatasvir. Treatment completion rate was 95% in PG patients compared to 89% pre-PG (p=0.03). Fewer PG patients completed lab work for sustained virologic response (SVR) at 61% (vs 88% pre-PG) however, SVR rate was similar between both groups (96% pre-PG and 99% PG, p=NS). Active drug use or OAT was not associated with treatment completion or SVR in either group. Conclusion: The COVID-19 pandemic has led to a decrease in HCV treatment rates. However, treatment completion and SVR rates remained high among those treated, suggesting minimal-pre-treatment investigations and use of telemedicine can optimize scarce resources with similar efficacy. (Figure Presented)