Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Ann Hepatol. 2022 May-Jun;27(3):100685. doi: 10.1016/j.aohep.2022.100685. Epub 2022 Feb 19.
The COVID-19 pandemic imperiled the global health system. We aimed to determine the impact of COVID-19 on the care continuum of HCV-infected patients.
Two hundred and fifty-six patients who were prescribed a course of DAA therapy at three tertiary medical centers in the US and China between January 1, 2019 to June 30, 2020 were included. We assessed the proportions of patients who completed DAA therapy and had HCV RNA testing during and after the end of therapy. We also assessed the impact of utilization of telemedicine.
The proportion of patients undergoing HCV RNA testing during DAA treatment decreased from >81.7% before pandemic to 67.8% during the pandemic (P=0.006), with a more prominent decrease in the US. There were significant decreases in HCV RNA testing >12 (P<0.001) and >20 weeks (P<0.001) post-treatment during COVID-19 era. Compared to pre-COVID period, post-treatment clinic encounters during COVID-19 era decreased significantly in China (Xi'an: 13.6% to 7.4%; Nanjing: 16.7% to 12.5%) but increased in the US (12.5% to 16.7%), mainly due to the use of telemedicine. There was a 4-fold increase in utilization of telemedicine in the US.
COVID-19 pandemic carried profound impact on care for HCV patients in both the US and China. HCV cure rate assessment decreased by half during COVID era but the proportion of patients finishing DAA therapy was not significantly affected. Increased utilization of telemedicine led to increased compliance with DAA therapy but did not encourage patients to have their laboratory assessment for HCV cure.
COVID-19 大流行危及全球卫生系统。我们旨在确定 COVID-19 对 HCV 感染患者连续护理的影响。
纳入 2019 年 1 月 1 日至 2020 年 6 月 30 日期间在美国和中国的三个三级医疗中心接受 DAA 治疗的 256 例患者。我们评估了在治疗期间和治疗结束后完成 DAA 治疗和 HCV RNA 检测的患者比例。我们还评估了远程医疗的利用情况。
在 DAA 治疗期间进行 HCV RNA 检测的患者比例从大流行前的>81.7%下降到大流行期间的 67.8%（P=0.006），美国的降幅更为显著。COVID-19 期间，治疗后 12 周（P<0.001）和 20 周（P<0.001）后 HCV RNA 检测的显著减少。与 COVID 前时期相比，COVID-19 期间治疗后门诊就诊次数在中国显著减少（西安：13.6%降至 7.4%；南京：16.7%降至 12.5%），而在美国显著增加（12.5%增至 16.7%），主要是由于远程医疗的使用。美国远程医疗的利用率增加了 4 倍。
COVID-19 大流行对中美两国 HCV 患者的护理产生了深远影响。COVID 时代 HCV 治愈率评估下降了一半，但完成 DAA 治疗的患者比例没有受到显著影响。远程医疗利用率的增加导致 DAA 治疗的依从性增加，但并未鼓励患者进行 HCV 治愈的实验室评估。
