COVID pandemic put hepatitis elimination efforts ‘further behind’

Consultations, testing and treatment of hepatitis B and C virus fell significantly during the first year of the COVID-19 pandemic, with many centers seeing declines of more than 75% in all categories, according to a presentation.

“Before COVID-19, very few countries were on track to reach the 2030 hepatitis C elimination goals set by WHO. COVID-19 has placed a significant strain on national health care systems at a critical moment of hepatitis elimination,” Maria Buti, MD, PhD, of the liver unit in the internal medicine department at Hospital Universitari Vall d’hebron in Barcelona, Spain, said during her presentation at The Liver Meeting Digital Experience. “The impact of COVID-19 on hepatitis C elimination has been estimated by mathematical models showing that a 1-year delay in hepatitis diagnosis and treatment could result in an additional number of liver cancers and deaths from HCV globally by 2030. However, there are scarce data in the real world.”

Going out to members of the European Association for the Study of Liver, Buti and colleagues conducted a prospective web-based survey from May 10 through October. Respondents measured total outpatient consultations and new referrals for HCV and HBV, tests performed for hepatitis B surface antigen (HBsAG), HBV RNA and HCV RNA, as well as number of patients who started HBV and HCV treatment. The centers reported on pre- and post-COVID numbers.

Outpatient HBV consults decreased by 30% (P = .001) with new referrals dropping by 39% (P < .001). Of the 37 centers, 76% (n = 28) saw reductions in outpatient referrals with 32% reporting a more than 75% drop. Specifically, 73% (n = 27) reported a drop in new referrals with 30% reporting a greater than 75% drop.

HCV consults declined by 45% (P < .001) with new referrals dropping by 49% (P < .001). Here, Buti showed that 30 centers (83%) reported a drop in outpatient consultations with 23% reporting a drop greater than 75% and 28 centers (78%) reporting a drop in new referrals.

When looking at testing, there was a 39% decrease in the number of HBsAg tests performed (P = .006) and a 24% decrease in the number of requested HBV DNA tests (P < .001). Half of the centers reported a reduction in HBV tests performed with 29% reporting a decrease of more than 75%.

Though the HCV RNA tests performed fell by just 4% (P = .003), 64% of the centers reported reductions in those tests with a quarter of those reporting a greater than 75% decline.

HCV treatment fell by 49% (P < .001) and 72% of centers reported a decline. HBV treatments saw a reduction of treatment initiation by 35% (P = .001) and a decline in treatment at 59% of centers reporting.

In looking at the 21 centers included in the WHO European region, Buti reported a 34% decline in HBV outpatient consultation (P = .002) and a 39% decrease in new referrals (P < .001) with 85% of centers reporting declines in consultations and new referrals. Though there was a decline in HBV treatment, it was not significant, Buti said.

Similarly in the 20 centers reporting from the WHO European region for HCV, she showed a 42% decline in outpatient consultations (P = .004) and a 49% decline in new referrals (P < .001) with 80% of the centers reporting a decline in consultations and 90% reporting a decline in new referrals. Unlike HBV treatment, though, there was a 48% decrease in HCV treatment (P < .001) and all but one center reported a decline in HCV treatments delivered with 26% reporting a decline greater than 75%.

“The COVID-19 pandemic has impacted significantly the care of patients with chronic viral hepatitis. In 2020, during the pandemic, the number of tests performed, consultations undertaken and new treatments provided decline significantly from 2019 in most centers surveyed,” Buti said. “COVID-19 has affected hepatitis testing and treatment services globally, putting elimination efforts further behind.”