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Impact of the 2020 COVID-19 Pandemic on Ambulatory Hepatitis C Testing
Heather Sperring1, Glorimar Ruiz-Mercado1, Elissa M Schechter-Perkins1,2
1Boston Medical Center, Boston, MA, USA.
Insights
The COVID-19 pandemic significantly reduced Hepatitis C (HCV) testing and identification, with telemedicine hindering access to essential HCV care. Adaptive strategies are crucial for HCV elimination efforts.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare Management
Background:
- The COVID-19 pandemic necessitated significant healthcare delivery changes in the U.S.
- Boston Medical Center (BMC) reduced in-person visits and routine preventive care, including Hepatitis C (HCV) testing, to manage resources during the surge.
- Telemedicine was integrated into clinical workflows.
Purpose of the Study:
- To evaluate the impact of COVID-19-related healthcare restructuring on HCV testing and identification rates.
- To assess changes in HCV testing and new positive identification both hospital-wide and within ambulatory settings.
Main Methods:
- Retrospective analysis of daily HCV test results at BMC.
- Comparison of testing data for 3.5-month periods before and after March 16th, 2020.
- Descriptive statistics were used to analyze total tests, new HCV RNA+ identifications, and mean daily tests.
Main Results:
- Hospital-wide HCV testing decreased by 49.6%, and new HCV+ identification dropped by 42.1%.
- Ambulatory clinic testing fell by 71.9%, with a 63.3% decrease in new HCV+ identification.
- Significant daily decreases in testing and new HCV+ identification were observed both hospital-wide and in ambulatory settings (P < .001).
Conclusions:
- The COVID-19 emergency response led to substantial reductions in HCV testing and identification.
- Telemedicine implementation acted as a barrier to HCV care, highlighting the need for monitoring public health initiatives within these workflows.
- Adaptive strategies are essential for continued HCV screening and progress toward elimination goals.
Introduction:
Coronavirus disease 2019 (COVID-19) has led to unprecedented modifications to healthcare delivery in the U.S. To preserve resources in preparation for a COVID-19 surge, Boston Medical Center (BMC) implemented workflows to decrease ambulatory in-person visits effective March 16th, 2020. Telemedicine was incorporated into clinical workflows and much preventive care, including Hepatitis C (HCV) testing, was not routinely performed.
Objective:
To explore the impact that the COVID-19 rapid restructuring response has had on HCV testing and identification hospital-wide and in ambulatory settings.
Methods:
BMC utilizes reflex confirmatory testing for HCV. When a sample is HCV Ab positive, it is automatically reflexed for confirmatory RNA and genotype testing. HCV test results for patients were collected daily. We compared unique patient tests for 3.5 month periods before and after March 16th, 2020. Descriptive statistics showed total tests and total new HCV RNA+ before versus after, both hospital-wide and in ambulatory clinics alone. Mean daily tests completed were compared.
Results:
Hospital-wide, total HCV testing decreased by 49.6%, and new HCV+ patient identification decreased by 42.1%. In ambulatory clinics, testing decreased by 71.9%, and new HCV+ identification decreased by 63.3%. Hospital-wide, mean daily tests decreased by 22.9 tests per day (95% CI: 17.9-28.0, P < .001), and mean daily new HCV+ identification decreased by 0.36 (95% CI: 0.20-0.53, P < .001). In ambulatory clinics, mean daily tests decreased by 22.1 tests per day (95% CI: 17.5-26.7, P < .001) and mean daily HCV+ decreased by 1.40 (95% CI: 1.03-1.76, P < .001).
Conclusion:
The COVID-19 systematic emergency response led to decreased HCV testing and identification, and in this regard telemedicine acts as a barrier to HCV care. Other public health initiatives must be monitored in the context of telemedicine workflows. Continued monitoring of HCV screening trends is vital, and adaptive approaches to work toward the goal of HCV elimination are needed.
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