COVID-19 pandemic led to a 30% drop in new hepatitis C treatments in the United States

Keith Alcorn
22 March 2022
Africa Studio/

Hepatitis C testing and treatment initiations in the United States dropped by 30% at the beginning of the COVID-19 pandemic in 2020 and treatment initiations did not recover to previous levels during 2020, an analysis of testing and treatment data published in the journal Clinical Infectious Diseases shows.

Modelling based on these findings, presented last month at the 2022 Conference on Retroviruses and Opportunistic Infections, indicates that if the reduction in treatment initiation was sustained for at least two years, the number of deaths due to hepatitis C would be almost twice as high than if the reduction in treatment initiation only lasted one year.

The University of California San Diego research group who published the study say that the United States will fall even further behind on hepatitis C elimination goals as a result of COVID-19, so that intensified efforts will be needed to screen and diagnose hepatitis C and link people to treatment.  

The UCSD researchers assessed hepatitis C testing and treatment activity in the United States from a national database that integrates data on laboratory testing and prescriptions.

The researchers compared the numbers of HCV antibody tests, RNA tests, genotype tests and treatment initiations between the period January 2019 and March 2020 (pre-COVID) and the period April 2020 and December 2020 (COVID-19 pandemic). These data were used to estimate tests and treatment starts for each state, as well as by age. Sub-analyses were carried out for four large states (New York, California, Illinois and Florida) to assess the impact of the timing of shutdowns on hepatitis C testing rates.

At the beginning of the pre-COVID period, 806,774 hepatitis C antibody tests were carried out in January 2019. Antibody test numbers fell by 0.8% per month up to March 2020 and then dropped by 37% (-238,473 tests) from March to April 2020. Test numbers rebounded to pre-COVID levels by the end of 2020.

The decline in antibody testing tracked the 42% fall in emergency room visits between early March and April 2020, the researchers note.

Hepatitis C treatment initiations fell by 31% during the early months of the pandemic but did not recover to pre-COVID levels by the end of 2020. The researchers note that the time between diagnosis and linkage to care doubled among people diagnosed with hepatitis C at the UCSD emergency department, suggesting that hesitancy to engage with health services may explain the lower treatment initiation rate. The timing and extent of lockdown did not affect the rate of treatment initiation.

The San Diego group also developed a mathematical model that simulated the impact of varying durations of suppressed treatment initiation on HCV-related mortality and on the incidence of new infections. The model assumed that 2.4 million had chronic hepatitis C in 2015, that just under half were aware of their infection by 2014 and that 44% of people who inject drugs had hepatitis C in 2018.

They modelled three scenarios: no change in treatment uptake, a 30% reduction in uptake lasting one year or a 30% reduction in uptake lasting two years.

Hepatitis C incidence among people who inject drugs would increase slightly under the two-year disruption scenario, although the impact of this increase on achievement of the HCV elimination target of an 80% reduction in incidence by 2030 would be marginal. The model shows that under all scenarios, HCV incidence will decline by approximately 5% between 2015 and 2030, far short of the target.

Mortality due to hepatitis C would be greater in the case of a two-year disruption. The model finds that approximately 800 additional deaths would occur as a result of a two-year disruption compared to a one-year disruption and overall, a two-year disruption would lead to a 20% reduction mortality by 2030.


Hoenigl M et al. Sustained impact of the COVID-19 pandemic on HCV treatment initiations in the United States. Clinical Infectious Diseases, published online, 2 March 2022.

DOI: 10.1093/cid/ciac175

Flores Ortega RF et al. Modelling the impact of the COVID-19 pandemic on hepatitis C elimination in the United States. Conference on Retroviruses and Opportunistic Infections, abstract 72, 2022.