- University of California, San Diego, California, USA.
- Medical University of Graz, Austria.
- University of Bristol, UK.
- Rush University Medical Center, Chicago, Illinois.
Background: Recent reports indicated declines in HCV testing during the first half of 2020 in the United States due to COVID-19, but the longer-term impact on HCV testing and treatment is unclear.
Methods: We obtained monthly state-level volumes of HCV antibody, RNA and genotype testing and HCV treatment initiation, stratified by age and gender, spanning January 2019 until December 2020 from two large national labs (Quest and LabCorp). We performed segmented regression analysis for each state from a mixed effects Poisson regression model with Month as the main fixed predictor, and State as a random intercept.
Results: During the pre-COVID period (January 2019-March 2020), monthly HCV antibody and genotype tests decreased slightly while RNA tests and treatment initiations remained stable. Between March and April 2020, there were declines in the number of HCV antibody tests (37% reduction, p<0.001), RNA tests (37.5% reduction, p<0.001), genotype tests (24% reduction, p=0.023) and HCV treatment initiations (31%, p<0.001). Starting April 2020 through the end of 2020 there were significant increases in month-to-month HCV antibody (p<0.001), RNA (p=0.035), and genotype tests (p=0.047), but only antibody testing rebounded to pre-COVID levels. HCV treatment initiations remained low after April 2020 throughout the remainder of the year.
Conclusion: HCV testing and treatment dropped by over 30% during April 2020 at the start of the COVID pandemic, but while HCV testing increased again later in 2020, HCV treatment rates did not recover. Efforts should be made to link HCV positive patients to treatment and revitalize HCV treatment engagement by health care providers.