Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019

Hepatitis C virus micro-elimination in vulnerable populations before and during a global pandemic

OBJECTIVE

to analyze a hepatitis C virus (HCV) microelimination strategy targeting vulnerable populations and the influence of the pandemic on its maintenance and outcomes.

METHODS

in 2018, the Hepatology Unit implemented an HCV microelimination strategy for patients attending drug addiction care centers and Psychiatry Units such as the Alcoholism Treatment Unit. These centers reported suspected or confirmed cases of HCV infection directly to the hepatologists, who, after reviewing the clinical records, cite those patients if necessary.

RESULTS

from June 2018 to February 2020, hepatologists were consulted on 37 anti-HCV positive patients, 31 of them were from Drug Addiction Care Centers, 5 from the Alcoholism Disorders Unit and 1 from the Department of Psychiatry. Fibrosis stage: F0-F1, 18 (50%); F2, 9 (25%); F3, 2 (4.2%); F4, 8 (20.8%). Female sex, 6 (16.7%). Required attending: Yes, 27 (73%). 25 (92.6%) went. Outpatient consultation: 10 (27%). Required treatment: 19 (51.3%). Sustained virological response: 19 (100%). Fibrosis stage of treated patients: F0-F1, 13 (68%); F2, 2 (11%); F3, 1 (5%); F4, 3 (16%). Patients from the Psychiatry Department during 2021: 11. 9 (82%) do not need to attend; 2 (18%): their situation is unknown.

CONCLUSIONS

sustained communication with centers that care for populations at risk of active HCV infection is needed to detect cases, increase adherence to treatment, and rescue patients who require screening for hepatocarcinoma.

Hepatitis C diagnosis slowdown in high-prevalence groups and using decentralised diagnostic strategies during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has had a major impact on hepatitis C virus (HCV) diagnosis by hindering the path to elimination, although probably in an uneven manner depending on the risk group and diagnostic strategy.

METHODS

We recorded the requests of antibodies/RNA by venipuncture at the hospital and primary care centres (centralised), as well as the requests via venipuncture or dried blood spot test at prison and drug treatment centres referred for central processing (integrated decentralised), for one year before and after the onset of the COVID-19 health alarm.

RESULTS

A total of 20,600 tests (51% male, 47.9±15.8 years) were recorded. Among them, 96.5% of the cases came from centralised and 3.5% from decentralised settings, with an active infection rate of 0.2% and 2.3% (p<0.001), respectively. There was a 31.3% decrease in the number of requests during the pandemic compared to the pre-pandemic period, which was more pronounced in decentralised diagnosis than centralised (60 vs. 30%, p<0.001). In addition, there was a 31.5% decline in screening and an 18.2% decrease in the diagnosis of new cases of active infection, showing a statistically significant decrease in decentralised compared to centralised diagnosis.

CONCLUSIONS

During the COVID-19 pandemic, a decline in HCV diagnostic effort has been observed, especially in decentralised strategies with a higher prevalence of infection. Our results suggest a diagnostic delay that will prevent Spain from reaching the elimination target in 2023, and therefore the reactivation of strategies particularly targeting the priority groups is urgently required.