The impact of COVID-19 and related control measures on the hepatitis C virus care cascade

Measures taken to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission have limited access to healthcare services worldwide. Declining testing volumes, diagnosis and treatment rates for blood-borne infections such as hepatitis C virus (HCV) were reported in England during early phases of the coronavirus disease 2019 (COVID-19) pandemic, showing significant disruptions in healthcare provision for these illnesses. These disruptions may have long-term implications for people who already face barriers to accessing care and are at increased risk of infection, complications and death, including people who inject drugs (PWID), who are also affected by the ongoing opioid overdose crisis; gay, bisexual, and other men who have sex with men (gbMSM); immigrants; and incarcerated persons. HCV care cascades can identify gaps in healthcare service provision along the HCV care journey, including: (i)antibody diagnosis, (ii)ribonucleic acid (RNA) testing, (iii)RNA positive diagnosis, (iv)genotyping, (v)treatment and (vi)cure. Large declines in HCV testing and diagnosis rates were reported in British Columbia (BC) and Ontario (ON) at the start of the pandemic, however comprehensive data on the full care cascade are currently unavailable. Data is also lacking on pandemic related changes in HCV care in other Canadian provinces, which are needed to assess and mitigate the effect of the pandemic impacts on the health of people living with HCV in Canada, especially among priority populations. Using testing and administrative data from BC and ON, this project aims to assess the impact of the COVID-19 pandemic and related control measures on (i)HCV care cascades in BC and ON; and (ii)HCV reinfection and death among PWID, gbMSM and immigrants. Surveys conducted among people from priority populations listed above and among healthcare providers will complement care cascade data and provide details on, and practical solutions to, on-the-ground impacts of the pandemic.