COVID-19 slows viral hepatitis elimination, global survey finds

22 Feb 2021 Keith Alcorn
Originally published on www.infohep.org

COVID-19 has caused substantial disruption to viral hepatitis screening and treatment, a global survey finds, but has also led to improvements in laboratory capacity and telemedicine that will benefit future efforts to eliminate hepatitis B and C.

The Coalition for Global Hepatitis Elimination carried out a 53-question online survey of doctors and programme managers between August and December 2020. They asked about the impact of COVID-19 on service delivery and how respondents had participated in the COVID-19 response. They also asked about the measures adopted to safely deliver testing and treatment services, and any perceived benefits of the COVID-19 pandemic for hepatitis care.

One hundred and three clinicians from 44 countries responded to the survey. Just over half were in the Americas, including 16 respondents in the United States, 28 in Africa and 15 in the European region. Most respondents (86%) were doctors or nurses.

Survey responses, mostly given before the second wave of hospitalisation in the Americas, Europe and South Africa, showed that the peak of disruption to hepatitis care had occurred between February and May 2020. Almost two-thirds of respondents reported that over half of in-patient visits had been deferred during that period.

More specifically, 39% of hepatitis C specialists reported a > 50% decline in treatment numbers and 28% reported > 50% reductions in the number of people tested for hepatitis C. Hepatitis B specialists less often reported substantial reductions in treatment numbers.

Of those providing opioid substitution therapy, one in five reported substantial reductions (> 50%) in the number of people accessing opioid substitution therapy.

Programme managers reported disruption to the supply chain for diagnostics and drugs. Twenty-seven per cent reported disruption of hepatitis C diagnostic and drug supplies and 21% reported disruption of hepatitis B diagnostics.

Hepatitis specialists were also diverted to COVID-19 testing or care. Thirty-one per cent reported that at least 25% of their time had been reallocated to COVID-19 work.

Although service levels were returning to normal by the time of the survey, 80% said that they were still seeing fewer patients than normal. This trend was especially pronounced in Africa. Patient reluctance to venture out of the home and into healthcare systems was judged to be the main reason for lower activity.

To mitigate service delivery problems caused by COVID-19, clinicians reported an increase in the quantity of medication being dispensed in each prescription, especially in Africa. Switching patient appointments to telemedicine (phone or video consultations) happened more frequently in the Americas and Europe, as did deferral of laboratory tests and imaging.

Forty-seven per cent of respondents said that increases in laboratory capacity due to COVID-19 testing would benefit hepatitis screening, while 48% said improvements in healthcare worker training would aid hepatitis elimination. The expanded use of telemedicine could also increase capacity.