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. 2023 Jan;16(1):64-70.
doi: 10.1016/j.jiph.2022.11.021. Epub 2022 Nov 19.

Modeling HCV elimination recovery following the COVID-19 pandemic in the United States: Pathways to regain progress

Sarah Blach  1 , Kimberly A Brown  2 , Robert S Brown  3 , Pierre M Gholam  4 , Norah A Terrault  5 , Chris Estes  1 , Homie A Razavi  6
Affiliations

Modeling HCV elimination recovery following the COVID-19 pandemic in the United States: Pathways to regain progress

Sarah Blach et al. J Infect Public Health. 2023 Jan.

Abstract

Background: As of 2019, the United States (US) was not on track to achieve targets for elimination, due to increasing incidence and treatment barriers. In 2020, the COVID-19 pandemic disrupted HCV services globally and in the US. As healthcare services normalize, there is an urgent need to reassess progress and evaluate scenarios that restore a pathway toward HCV elimination.

Methods: We updated a validated Markov model to estimate HCV-related morbidity and mortality in the US. Five scenarios were developed to bookend possible HCV outcomes in the wake of the pandemic. These included 1) return to pre-COVID-19 treatment forecasts; 2) achieve elimination targets through treatment and harm reduction; 3) long-term treatment disruptions; 4/5) achieve elimination targets through increased treatment without increased harm reduction, starting in either 2022 or 2025.

Findings: From 2014-2019, more than 1.2 million patients were treated for HCV in the US. Elimination targets in 2030 could be achieved in the US by treating an additional 3.2-3.3 million patients from 2020 to 2030, or by preventing new infections through expanded harm reduction programs and treating up to 2.7 million patients. Intervention scenarios could prevent over 30,000 HCC cases and over 29,000 liver-related deaths.

Interpretation: The US has made strides toward HCV elimination, but gains could be lost in the wake of the pandemic. However, it is still possible to avert nearly 30,000 deaths through increased harm reduction and increased treatment rates. This requires a coordinated effort from the entire HCV community.

Keywords: COVID-19; Elimination; Hepatitis C Virus; United States.

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Conflict of interest statement

Competing interests SB and CE are employees of the Center for Disease Analysis Foundation (CDAF). Over the past 3 years, CDAF has received research grants from Gilead and AbbVie. CDAF has also received grants from CDC Foundation, John C. Martin Foundation, ASTHO, Zeshan Foundation, and private donors. KB reports grants from Sagimet, Gilead, Salix, Novonordisk, Allergan and Intercept. RB reports grants and research support from Abbvie and Gilead. PMG reports consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead Sciences and AbbVie. NT reports grants or contracts from Gilead Sciences, Genentech, Roche; consulting fees from EXIGO Mgmt LLC, ENYO, PPD Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from University of Maryland. HR reports being a member of advisory boards for Gilead, AbbVie, Abbott, Merck. CDA has received research funding from Gilead, Assembly Biosciences, AbbVie, and Roche. CDA Foundation has received research grants from Gilead.

Figures

Fig. 1
Fig. 1
Scenario inputs.
Fig. 2
Fig. 2
Change in viremic HCV infections, 2006–2020 & Cascade of Cascade, 2020.
Fig. 3
Fig. 3
Progress toward the WHO 2030 targets for liver-related deaths and incidence of HCV – United States, 2015–2030.
See this image and copyright information in PMC

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