Impact of COVID-19 pandemic on hcv care cascade in rwanda: Ecological study from july 2019 to june 2020

ABSTRACT

Background: Many services including those related to hepatitis C virus (HCV) care were disrupted during the COVID-19 pandemic. We assessed the impact of the COVID-19 pandemic on the HCV care cascade in Rwanda. Methods: This study used data from the Rwanda Health Management Information System. We included data for all individuals who received HCV services from screening to treatment and cure [sustained virological response at week 12 (SVR12)], from July 2019 to June 2020. We defined HCV care cascade as 1) HCV antibody (Ab) positive, 2) HCV RNA tested, 3) HCV RNA detectable, 4) patients eligible for treatment, 5) patients on treatment, 6) assessed for SVR12, 7) achieved SVR12. Results: Between July 2019 and June 2020, 1,909,450 persons were screened for HCV in Rwanda (95,899 screened from July to December 2019, and 1,813,551 from January to June 2020). From January 2020, HCV elimination plan was implemented, with an increased allocation of resources for HCV-related services. Overall, 60,961 people (3.19%) were screened positive for HCV-Ab, the highest prevalence in November 2019 (11.9%), and the lowest in June 2020 (1.47%). Among those who were HCVAb positive, 31.33% (47.54% in 2019 vs 29.1% in 2020) were tested for HCV RNA, and 77.63% of those had a detectable viral load (77.63% in both 2019 and 2020). Of 25,056 people eligible for HCV treatment (people over 17 years old, nonpregnant or breastfeeding women, patients without HCC), 69.76% started treatment (95.14% in 2019 vs 52.15% in 2020). Among 6,714 who completed HCV treatment, 50.59% (22.34% in 2019 vs 74.49% in 2020) were assessed for SVR12. From July 2019 to June 2020, the number of people screened for HCV-Ab increased, while the proportion of patients tested for HCV RNA among those who were HCVAb positive decreased from October 2019. Conclusion: The number of people screened and treated for HCV increased in Rwanda during the study period. Overall, more people were screened during the period of early 2020 compared to the later part of 2019, suggesting that the COVID-19 pandemic did not disrupt screening. However, the proportion of patients who received subsequent services in the HCV care cascade are still low and decreased in 2020 compared to 2019, which is likely due to the impact of the COVID-19 pandemic. There is a need to plan the re-engagement of individuals who may have experienced delays in hepatitis care during the COVID-19 pandemic in order to achieve the hepatitis elimination goals. .