Viral hepatitis tests and treatment declined significantly
during 2020 as a consequence of the COVID-19 pandemic, a survey of 31 liver
centres on five continents has shown. The decline in testing and treatment initiation
delays progress towards hepatitis C elimination, said Professor Maria Buti, of
the Vall d’Hebron University Hospital, Barcelona. She presented the survey
findings at The Liver Meeting on Saturday.
The COVID-19 pandemic has led to major adjustments in medical
services, including online consultations, cancellation of surgery and minimal
face-to-face non-urgent medical care in many settings. But the pandemic has had
varying effects on services. In
the HIV field, for example, treatment services in Europe have been less
affected than testing.
The impact on viral hepatitis testing and treatment is
unclear. In the United States, the number of people treated for hepatitis C in
2020 fell by a quarter compared to 2019, the US Centers for Disease Control and Prevention reported
last week.
To evaluate the impact of the pandemic on viral hepatitis
care, European liver experts designed an internet survey, sent to members of
the European Association for the Study of the Liver (EASL), international
hepatitis experts and liver units in Europe. The survey asked about total
numbers of patients in care, numbers of patient consultations and new referrals,
numbers tested for chronic hepatitis B and C, confirmatory DNA and RNA testing,
the number of patient consultations and the numbers initiated on treatment for hepatitis
B and C in 2019 (pre-COVID-19) and 2020 (since the onset of the COVID-19
pandemic).
Thirty-seven liver centres responded (20 in Europe and 17 in
other regions), of which 31 provided full data.
Hepatitis B outpatient assessments fell by 30% in 2020 compared
to 2019 while hepatitis C outpatient assessments by 45%, the survey found. New
hepatitis B referrals (a surrogate for new diagnoses) fell by 39, while new
hepatitis C referrals fell by 49% (all changes p<0.001).
Thirty-four centres provided information on hepatitis B testing,
reporting a 39% reduction in HBsAg tests and a 24% reduction in HBV DNA tests
between 2019 and 2020 (p=0.006 and p<0.001 respectively). Seventeen centres
reported overall reductions in testing activity.
Hepatitis C confirmatory testing was less affected, falling
by 4% overall, although 20 out of 31 centres reporting on this measure saw
reductions in testing, half by at least 50%.
Hepatitis B treatment initiation fell by 35% (p<0.001).
Nineteen centres saw reductions in activity.
Hepatitis C treatment initiation also fell, by 49%
(p<0.001), and 26 of the 34 centres reporting on this measure experienced
reductions in treatment initiation.
The variation between centres in testing and treatment initiation
is partly explained by the differences in severity of COVID-19 between
countries, said Maria Buti, but also by heterogenous health systems. When the survey
was confined to centres in the WHO Europe region (21 clinics) and to the
reporting of patient referrals or new consultations, and treatment initiation,
the impact on hepatitis care was more pronounced.
The number of consultations and new patient referrals for
hepatitis B fell by 34% and 39% respectively (p=0.002 and p<0.001 respectively)
in the WHO Europe region centres. Eighteen of the 21 centres reported reductions
in activity and 44% reported that new referrals had fallen by at least half.
Twenty clinics reported on hepatitis C activity. Outpatient
consultations fell by 42% and new referrals by 49% and 18 out of 20 centres
reported reductions in new referrals.
Although 14 out of 18 centres reporting on hepatitis B treatment
initiation saw reductions in treatment initiation, the overall reduction was
non-significant (-17%, p=0.055) and the absolute number starting treatment fell
by less than 200.
But in the case of hepatitis C, the number of patients starting
treatment almost halved (-48%, p<0.001), falling by 1159 patients across the
20 centres reporting on treatment initiation. Nineteen out of 20 centres
reported reductions and 58% reported that treatment initiation fell by at least
half in 2020 at their centre.
Further research will be needed to investigate longer-term
trends in viral hepatitis referral, testing and treatment, said Professor Buti.