Impact of COVID-19-related Public Health Measures on HCV Testing in British Columbia, Canada

An Interrupted Time Series Analysis

Mawuena Binka; Sofia Bartlett; Héctor A. Velásquez García; Maryam Darvishian; Dahn Jeong; Prince Adu; Maria Alvarez; Stanley Wong; Amanda Yu; Hasina Samji; Mel Krajden; Jason Wong; Naveed Z. Janjua

Disclosures

Liver International. 2021;41(12):2849-2856. 

In This Article

Abstract and Introduction

Abstract

Background & Aims: Public health measures introduced to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), also disrupted various healthcare services in many regions worldwide, including British Columbia (BC), Canada. We assessed the impact of these measures, first introduced in BC in March 2020, on hepatitis C (HCV) testing and first-time HCV-positive diagnoses within the province.

Methods: De-identified HCV testing data for BC residents were obtained from the provincial Public Health Laboratory. Weekly changes in anti-HCV, HCV RNA and genotype testing episodes and first-time HCV-positive (anti-HCV/RNA/genotype) diagnoses from January 2018 to December 2020 were assessed and associations were determined using segmented regression models examining rates before vs after calendar week 12 of 2020, when measures were introduced.

Results: Average weekly HCV testing and first-time HCV-positive diagnosis rates fell immediately following the imposition of public health measures by 62.3 per 100 000 population and 2.9 episodes per 1 000 000 population, respectively (P < .0001 for both), and recovered in subsequent weeks to near pre-March 2020 levels. Average weekly anti-HCV positivity rates decreased steadily pre-restrictions and this trend remained unchanged afterwards.

Conclusions: Reductions in HCV testing and first-time HCV-positive diagnosis rates, key drivers of progression along the HCV care cascade, occurred following the introduction of COVID-19-related public health measures. Further assessment will be required to better understand the full impact of these service disruptions on the HCV care cascade and to inform strategies for the re-engagement of people who may have been lost to care because of these measures.

Introduction

In 2016, Canada, alongside other World Health Organization (WHO) member states, committed to eliminating the threat that hepatitis C virus (HCV) poses to public health worldwide by 2030.[1] To that end, many member states have implemented policies and strategies to facilitate the attainment of the disease prevention, healthcare provision and mortality-reduction goals that form the cornerstone of this Global Health Sector Strategy.[1–3] Canada is making significant progress towards meeting the 2030 elimination goals, with the provision of unrestricted access to publicly funded therapy for persons with chronic HCV infection and elimination efforts being initiated in many provinces, including British Columbia (BC).[4–6] Testing is a key component of these efforts, and is the first step to engaging people living with HCV into care.[7]

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 led to the implementation of broad public health measures to prevent and control transmission of the virus and to preserve healthcare resources in many countries across the world, including Canada.[8–14] These measures have had sweeping economic, social and health-related impacts globally, including the disruption of healthcare services such as HCV prevention, testing, treatment and post-treatment follow-up.[15–17] Many people living with HCV have concurrent substance use or mental health challenges, are socially and materially deprived, and living with HIV or HBV co-infection.[18,19] Thus, given the syndemic nature of HCV infection, these service disruptions may have more profound short- and long-term impacts within these groups. Furthermore, HCV-related service disruptions could delay Canada's progression towards the achievement of the viral hepatitis elimination goals. In this study, the impact of COVID-19-related public health measures on HCV testing and first-time HCV-positive diagnoses within the province were assessed using population-level laboratory data as a first step towards understanding the potential impact of healthcare service disruptions on BC's HCV elimination efforts.

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