Division of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Yale University School of Public Health, New Haven, Connecticut, USA.
Clin Infect Dis. 2022 Aug 24;75(1):e1112-e1119. doi: 10.1093/cid/ciab779.
The coronavirus disease 2019 (COVID-19) pandemic disrupted access to and uptake of hepatitis C virus (HCV) care services in the United States. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes.
We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12 and 24 months.
Compared to the "no pandemic" scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100 000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to "no pandemic," the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR.
A recommitment to the HCV epidemic in the United States that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.
2019 年冠状病毒病（COVID-19）大流行扰乱了美国获得和接受丙型肝炎病毒（HCV）治疗服务的机会。目前尚不清楚大流行将对长期 HCV 相关结局产生多大影响。
我们使用微观模拟来估计 COVID-19 对医疗服务的干扰对 HCV 结果的 10 年影响，包括已确定的感染、与治疗的联系、治疗的开始和完成、肝硬化和与肝脏相关的死亡。我们模拟了假设的情景，即在 2020 年 3 月开始的为期 18 个月的与 COVID-19 相关的 HCV 护理中断后，根据到 2030 年 3 月恢复到与大流行前水平的筛查、联系和治疗率的不同情况进行比较，并将其与没有 COVID-19 大流行或护理中断的反事实情况进行比较。我们还进行了替代方案分析，其中大流行中断持续了 12 个月和 24 个月。
与“无大流行”情况相比，在没有恢复到 HCV 护理提供的大流行前水平的情况下，我们估计每 10 万人中会减少 1060 例确诊病例、21 例额外的肝硬化病例和 16 例额外的与肝脏相关的死亡病例。只有 3%的确诊病例开始治疗，不到 1%的患者达到持续病毒学应答（SVR）。与“无大流行”情况相比，在最好的情况下，即 18 个月的护理中断后恢复到大流行前水平，我们估计确诊病例和达到 SVR 的比例较小。
美国需要重新投入 HCV 流行，这需要额外的资源，以及积极努力筛查、联系和治疗 HCV 感染者，以克服与 COVID-19 相关的干扰。
