A slowdown of hepatitis C diagnosis in high-prevalence groups and with decentralized 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. Albeit, in an uneven manner, depending on the risk group and diagnostic strategy. METHODS: the requests of antibodies/RNA by venipuncture at hospitals and Primary Care centers (centralized) and via venipuncture or dried blood spot tests at prison and drug treatment centers referred for central processing (integrated decentralized) were recorded for one year, before and after the onset of the COVID-19 health crisis. RESULTS: a total of 20,600 tests (51 % male, 47.9 ± 1 5.8 years) were recorded. Among them, 96.5 % of the cases came from centralized and 3.5 % from decentralized 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 the decentralized than centralized diagnosis setting (60 vs 30 %, p < 0.001). In addition, there was a 31.5 % decline in screening and 18.2 % decrease in the diagnosis of new cases of active infection, with a statistically significant decrease in decentralized compared to centralized diagnosis. CONCLUSIONS: during the COVID-19 pandemic, a decline in HCV diagnostic effort was observed, especially in decentralized strategies, with a higher prevalence of infection. Our results suggest a diagnostic delay that will prevent Spain from reaching the elimination target in 2023. Therefore, the reactivation of strategies, particularly targeting the priority groups, is urgently required.

Telemedicine and decentralized hepatitis C treatment as a strategy to enhance retention in care among people attending drug treatment centres.

BACKGROUND: People attending drug treatment centres have a high burden of hepatitis C virus (HCV) and face barriers to diagnosis and treatment. Dried blood spot (DBS) testing has been proposed to simplify diagnosis, but many patients remain untreated. In this retrospective study, we evaluated the reasons for non-retention in care in an intervention using on-site DBS testing and the effect of telemedicine and decentralized care compared to standard of care among people attending drug treatment centres who were lost to follow-up. METHODS: In a first phase, retention in care, adherence to treatment, and predictive factors in the DBS testing program of patients in drug treatment centres were analyzed and compared to a cohort of patients treated at the hospital outpatient clinic. Subsequently, in a second phase we evaluated in patients lost to follow-up from drug treatment centres the efficacy of one-step testing and telemedicine linked to a decentralized dispensation of HCV treatment or standard of care. RESULTS: Among 512 patients attending drug treatment centres, 467 (91.2%) agreed to be tested and 53.4% (237 patients/444 valid tests) tested positive (46 ± 9 years, 87.3% male) for HCV antibodies. After excluding patients negative for RNA or under surveillance, 178 patients were scheduled to meet with a specialist. Overall, 44 patients did not attend and 25 did not complete the pre-treatment evaluation. The only factor associated with retention in care was patient's knowledge of HCV infection. Treated patients attending drug treatment centres (n = 68) compared to the hospital outpatient clinic cohort (n = 135) had lower rates of treatment adherence. Among the patients who attended drug treatment centres that were lost to follow-up (n = 69), the proportion of patients who completed the program was significantly higher among those assisted by telemedicine than by standard of care (62.5% vs. 24.3%, p = 0.002). CONCLUSION: Although there was a high participation rate in a DBS testing program in drug treatment centres, non-retention in care is a challenge. Importantly, telemedicine linked to a decentralized dispensation of HCV treatment re-engages patients and may be effective for HCV microelimination.

Mayor ralentización en el diagnóstico de la hepatitis C en estrategias descentralizas y en grupos de alta prevalencia durante la pandemia por COVID-19 / A slowdown of hepatitis C diagnosis in high-prevalence groups and with decentralized diagnostic strategies during the COVID-19 pandemic

Introducción: la pandemia por COVID-19 ha tenido una importante repercusión en el diagnóstico del virus de la hepatitis C (VHC) obstaculizando el camino hacia su eliminación,aunque es probable que de forma desigual según la estrategia diagnóstica y el grupo de riesgo.Métodos: se registraron las solicitudes de anticuerpos/ARNpor venopunción en hospital y Atención Primaria (centralizado) y mediante venopunción o test de gota de sangre seca enprisión y centros de drogodependencias remitidos para procesamiento central (descentralizado integrado) durante un añoantes y después del inicio de la alerta sanitaria por COVID-19.Resultados: se registró un total de 20.600 determinaciones(51 % varones, 47,9 ± 15,8 años) realizadas el 96,5 % deforma centralizada y el 3,5 % de forma descentralizada,con una tasa de infección activa del 0,2 % y el 2,3 %(p < 0,001), respectivamente. Durante el periodo de pandemia, comparado con el de prepandemia, hubo un descensoen el número de determinaciones del 31,3 %, que fue mayor en diagnóstico descentralizado comparado con centralizado (60 vs. 30 %, p < 0,001). Además, se contabilizó undescenso en el cribado del 31,5 % y en el diagnóstico denuevos casos de infección activa, del 18,2 %, con mayordescenso en el diagnóstico descentralizado comparado concentralizado.Conclusiones: durante la pandemia por COVID-19 se ha objetivado un descenso en el esfuerzo diagnóstico del VHC,especialmente en estrategias descentralizadas y con mayorprevalencia de infección. Estos resultados sugieren un retraso diagnóstico que dificultará alcanzar la meta de eliminación en nuestro país en 2023, por lo que urge reactivarestrategias principalmente en grupos prioritarios. (AU)