Simplified treatment of hepatitis C during the COVID-19 pandemic: retrospective analysis of the British Columbia Hepatitis C Network

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Background: The COVID-19 pandemic changed the landscape of hepatitis C virus (HCV) treatment in Canada. In this study, we sought to describe the characteristics, management, and outcomes of patients treated during the pandemic. Methods: Retrospective analysis of the British Columbia HCV Network included HCV patients treated from March 17, 2018 to February 22, 2022. Patients who started treatment before and after March 17, 2020 were designated pre-pandemic and pandemic groups, respectively. Patients were followed until sustained virologic response 12 weeks post-treatment (SVR12). Results: A total of 851 patients underwent 854 treatments, with 481 (56%) pre-pandemic and 373 (44%) pandemic. Pandemic patients were younger (median age 57 versus 61 pre-pandemic; p <0.01) and 23% were on opioid agonist therapy (versus 11% pre-pandemic; p = 0.01). Fewer pandemic patients completed transient elastography (36% versus 56% pre-pandemic; p < 0.01). Pandemic patients utilized fewer in-person appointments and more telehealth appointments ( p < 0.01). Fewer pandemic patients completed treatment (85% versus 91% pre-pandemic; p = 0.23); the SVR12 rate was 97.8% in those completing treatment and lab work (versus 99.5% pre-pandemic; p < 0.01). Younger age, substance use, and opioid agonist therapy were associated with loss to follow-up during the pandemic. Conclusions: Patients treated for HCV in British Columbia during the pandemic utilized fewer resources and had more loss to follow-up but maintained high SVR12 rates. Transitioning from in-person to telehealth appointments proved effective in a real-world setting. Individualized strategies are required for special populations prone to loss to follow-up.

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