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Published on: December 15, 2023
Impact of COVID-19 Pandemic on Testing for Hepatitis B in British Columbia, Canada: An Interrupted Time Series
Richard L Morrow1,2, Jean D Makuza1,2, Dahn Jeong1,2
1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
The COVID-19 pandemic reduced hepatitis B virus (HBV) testing, particularly for people who inject drugs (PWID). Testing remained lower than expected through 2022, indicating a need for increased HBV screening and care linkage for PWID.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Previous studies indicated early COVID-19 pandemic reductions in hepatitis B virus (HBV) testing.
- The long-term impact of the pandemic on HBV testing, especially among people who inject drugs (PWID), remained unclear.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic and related policies on HBV testing rates.
- To analyze trends in HBV testing from 2020 to 2022, with a specific focus on PWID in British Columbia, Canada.
Main Methods:
- Utilized population data from the BC COVID-19 Cohort.
- Conducted interrupted time series analyses for HBV surface antigen (HBsAg), HBV DNA, and HBV e-antigen (HBeAg) testing.
- Examined data across prepandemic (Jan 2017-Feb 2020) and pandemic periods (2020-2022).
Main Results:
- HBsAg and HBV DNA testing decreased significantly in mid-2020 and remained below predicted levels through 2022.
- Reductions in HBV DNA testing were more pronounced for PWID (30.0%) compared to non-PWID (11.2%) in 2020.
- HBeAg testing changes were less significant overall but showed variations by sex and age.
Conclusions:
- The COVID-19 pandemic and associated policies led to sustained decreases in HBsAg and HBV DNA testing.
- There is an ongoing need for enhanced HBV screening strategies.
- Specific interventions are required to improve linkage to care for PWID, addressing disparities in HBV testing and outcomes.
Background:
Previous research suggests the COVID-19 pandemic was associated with reductions in HBV testing early in the pandemic. However, impacts of the pandemic on HBV testing in the longer-term and among people who inject drugs (PWID) are unclear. We investigated the impact of the pandemic and related policies on HBV testing from 2020 to 2022, including among PWID, in British Columbia (BC), Canada.
Methods:
Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses of HBV surface antigen (HBsAg), HBV DNA, and HBV e-antigen (HBeAg) testing. The study included a prepandemic period (January 2017-February 2020), a transition period (March-May 2020), and pandemic periods in 2020 (June-December), 2021, and 2022.
Results:
HBsAg testing decreased by 16.5% (95% CI 13.9-18.9) and HBV DNA testing decreased by 11.6% (95% CI 9.5-13.6) in June-December 2020 relative to predicted levels, and testing remained lower than predicted throughout 2021 and 2022. Percentage reductions in HBV DNA testing were greater for PWID compared with non-PWID in 2020 (30.0% vs 11.2%) and thereafter. Changes in HBeAg testing overall were less pronounced but varied by sex and age.
Conclusions:
The pandemic and related policies were associated with decreases in HBsAg and HBV DNA testing in 2020, and testing remained lower than predicted throughout 2021 and 2022. Additional efforts to increase HBV testing are needed, including strategies to ensure linkage to care for PWID.
