Projected Long-Term Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hepatitis C Outcomes in the United States: A Modeling Study

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted access to and uptake of hepatitis C virus (HCV) care services in the United States. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes.

Methods: We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12 and 24 months.

Results: Compared to the "no pandemic" scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100 000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to "no pandemic," the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR.

Conclusions: A recommitment to the HCV epidemic in the United States that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.

Keywords: COVID-19; coronavirus; elimination; hepatitis C; modeling.

Figure 1.

Cascade of care flow diagram. Flow diagram represents the steps of the HCV cascade of care, as well as key model parameters related to loss to follow-up. Arrows noted in the key represent points along the cascade at which candidate interventions improved follow-up. Individuals lost to follow-up prior to receiving their screening test results maintained a rate of re-screening such that their HCV status could be identified in the future. In addition, those who were lost to follow-up after obtaining screening test results had a monthly probability of relinking to HCV care. Abbreviations: HCV, hepatitis C virus; SVR, sustained virologic response.

Figure 2.

HCV cascade in March 2030 for identification, treatment initiation, and sustained virologic response, by scenario. This figure depicts the percent of individuals with HCV who were identified (black bar); the percent of those identified who are initiated on treatment (dark gray bar); and the percent of those who achieve SVR (light gray bar), by modeled scenario. Abbreviations: HCV, hepatitis C virus; SVR, sustained virologic response.

Figure 3.

Cases of cirrhosis and liver-related deaths relative to hypothetical “no pandemic” scenario, March 2030 (per 100 000 people). This figure depicts the estimated number of cases of cirrhosis (dark gray) and liver-related deaths (light gray) compared to the “no pandemic” scenario. Each group of bars represents a scenario in which 1 or more steps in the care cascade are doubled over the pre-pandemic levels for the time following an 18-month disruption in HCV services. Abbreviation: HCV, hepatitis C virus.