During the COVID-19 pandemic, testing and treatment initiation rates for patients with hepatitis C virus (HCV) infection significantly decreased in the United States. These findings were published in Clinical Infectious Diseases.

Researchers from University of California, San Diego sourced monthly state-level HCV testing and treatment data from the Symphony Health Dataverse, a nationally-representative integrated database. The volume of HCV antibody, RNA, and genotype testing, as well as HCV treatment initiations that occurred prior to the COVID-19 pandemic between January 2019 and March 2020 were compared with those that occurred between April and December 2020.

During the study period, there were 17,565,801 HCV antibody, 242,624 HCV RNA, 454,097 HCV genotype tests administered, and 173,925 HCV treatment initiations.

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During the prepandemic period, the monthly rate of HCV antibody testing decreased by 0.8% (P =.008) compared with 37% monthly between March and April 2020 (P <.001). Following the onset of the COVID-19 pandemic, the monthly rate of HCV antibody testing increased each month until August 2020 (P <.001) and then began to decrease in September 2020. The researchers noted that these results did not differ after stratification by State, patient sex, or age.

For HCV RNA tests, the prepandemic monthly testing rate decreased by 0.7% (P =.217). At the onset of the pandemic (March-April 2020), the monthly rate of HCV RNA testing decreased by 37.5% (P <.001) and increased by 3.6% monthly thereafter (P =.035). Results were similar after stratification by State, patient sex, and age. Of note, the rate of HCV RNA testing did not return to prepandemic levels by the end of 2020.

Similar results were observed for the monthly rate of HCV genotype tests administered. The researchers found that HCV genotype testing decreased by 1.9% (P <.001) during the prepandemic period, followed by a decrease of 24% (P =.023) at the beginning of the pandemic, and then an increase of 0.9% (P =.047) thereafter. By the end of 2020, the monthly rate of HCV genotype testing was decreased compared with the rate observed during the prepandemic period.

For HCV treatment initiation, the number of patients initiating treatment decreased by 31% (P <.001) between March and April 2020, and this decrease remained throughout the pandemic period.

States that adopted Medicaid expansion had stable rates of HCV treatment initiation in the prepandemic period. Of the states that did not adopt the Medicaid expansion, the rate of monthly HCV treatment initiations significantly decreased for each month of the prepandemic period (P =.014). After April 2020, the researchers conducted a comparison between states that adopted the Medicaid expansion vs those that did not, with results showing that the rate of HCV treatment initiations did not significantly differ (both P <.001). Unlike the rate of monthly HCV genotype, antibody, and RNA tests administered, results that showed a decrease in the monthly rate of HCV treatment initiations were similar to those observed after stratification by state, patient sex, and age.

This study may have been limited by the lack of data on patients’ race/ethnicity as it remains unclear whether there were any pandemic-related health disparities  in HCV testing or management.

According to the researchers, “[these findings indicate that] efforts should be made to link patients [with HCV] to treatment, and revitalize HCV treatment engagement by health care providers.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.


Hoenigl M, Abramovitz D, Ortega REF, Martin NK, Reau N. Sustained impact of the COVID-2019 pandemic on HCV treatment initiations in the United States. Clin Infect Dis. 2022;ciac175. doi:10.1093/cid/ciac175

This article originally appeared on Infectious Disease Advisor