Impact of the COVID-19 pandemic on hepatitis B and C elimination: An EASL survey

Abstract

Background & aims: The World Health Organization (WHO) HBV and HCV elimination targets, set in 2016 and based on projections to 2030, were unable to consider the impact of intervening factors. To evaluate the impact of the COVID-19 pandemic on viral hepatitis elimination programs, the European Association for the Study of the Liver (EASL) conducted a survey in liver centers worldwide in 2021.

Methods: A web-based questionnaire was distributed (May-July 2021) to all EASL members representing clinical units providing HBV and HCV hepatitis care. Results are expressed as absolute numbers and reduction rates for each care activity.

Results: Data were collected from 32 European and 12 non-European clinical centers. Between January 2019 (pre-pandemic) and December 2020 (during the pandemic), chronic HBV consultations decreased by 32% and 26%, new referrals by 38% and 39%, HBV testing rates by 39% and 21% (for HBsAg detection) and 30% and 22% (for HBV DNA detection), and new HBV treatments by 20% and 44% (p = 0.328) in European and non-European centers, respectively. With regard to HCV during the same time frame, the overall reductions were 39% and 50% for consultations, 49% and 49% for new referrals, 11% and 38% for HCV RNA detection, and 51% and 54% for new HCV antiviral treatments for European and non-European Centers, respectively (p = 0.071).

Conclusions: All steps in the viral hepatitis care cascade have been hampered by the COVID-19 pandemic, with a comparable impact across different centers. These data reaffirm the pandemic's major effect on global viral hepatitis elimination programs and suggest that actions to achieve the WHO 2030 targets should be reconsidered and revised to account for each country's progress relative to pre-pandemic values.

Lay summary: The EASL multinational survey conclusively shows that viral hepatitis elimination programs, expected to provide control of hepatitis B and hepatitis C worldwide by 2030, have been held back by the COVID-19 pandemic in clinical centers from several European and non-European countries, with a comparable impact across centers. Limitations in the cascade of care for both HBV and HCV were linked to limited access to screening, consultations, specific testing, and actual treatment. As restrictions for COVID-19 begin to lift, efforts to diagnose and provide treatment for viral hepatitis should remain high on the list of priorities for public health officials to maintain the WHO elimination efforts. Measures that have been put in place to control the COVID-19 pandemic could be transferred to increasing the diagnosis and linkage to care of people with hepatitis.

Keywords: COVID-19 pandemic; EASL, European Association for the Study of the Liver; EU Centers, European centers; Hepatitis B virus; Hepatitis C virus; Non-EU Centers, Non-European centers; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; WHO elimination targets; WHO, World Health Organization.

Graphical abstract

Fig. 1

HBV consultations, new referrals, and markers testing before and during the COVID-19 pandemic. The dark purple columns indicate numbers referring to the year 2019 (pre-pandemic) from the European and non-European centers. The light purple columns indicate numbers referring to the year 2020 (during the pandemic) from the European and non-European centers.

Fig. 2

Number of patients starting HBV and HCV treatment before and during the COVID-19 pandemic. The dark purple columns indicate numbers referring to the year 2019 (pre-pandemic) from the European and non-European centers. The light purple columns indicate numbers referring to the year 2020 (during the pandemic) from the European and non-European centers.

Fig. 3

Reduction rates in HBV testing and treatment during the COVID-19 pandemic. Different colors indicate the percent decrease for each marker analyzed. The percent decrease is expressed as the number inside each colored box on a scale of 100%.

Fig. 4

HCV consultations, new referrals, and HCV RNA testing before and during the COVID-19 pandemic. The dark purple columns indicate numbers referring to the year 2019 (pre-pandemic) from the European and non-European centers. The light purple columns indicate numbers referring to the year 2020 (during the pandemic) from the European and non-European Centers.

Fig. 5

Reduction rates in HCV testing and treatment during COVID-19 pandemic. Different colors indicate the percent decrease for each marker analyzed. The percent decrease is expressed as the number inside each colored box on a scale of 100%.