The number of patients with hepatitis C virus (HCV) infection in the US who initiated treatment with direct-acting antiviral agents (DAA) declined between 2015 and 2020, according to data from the CDC presented at the 2021 American Association of the Study of Liver Disease (AASLD) meeting.
The estimated annual number of people treated for HCV in the US was highest in 2015 (164,247) and lowest in 2020 (83,740); both of these numbers fall short of the National Academies of Science and Medicine’s goal of treating 260,000 people with HCV annually to achieve elimination of this disease by 2030. An estimated 2.4 million people in the US were living with HCV from 2013 to 2016, the CDC noted.
The CDC cited recent successes in increasing access to care with a reported threefold increase in the proportion of claims for HCV DAAs paid for by Medicaid between 2014 and 2020 as many states removed policy restrictions that prevented access to these treatments. Additionally, HCV treatment costs decreased during this time due to increased competition from drug makers, programs contracting for lower costs, and innovative state treatment models.
However, treatment barriers remain in many state Medicaid policies such as restrictions on provider-types who can manage treatment, sobriety requirements, and prior authorization processes before treatment initiation.
COVID-19 and Opioid Crisis Create New Access Barriers
The COVID-19 pandemic caused many patients to avoid seeking medical and preventative services, particularly in emergency departments and primary care settings where most HCV testing takes place, the CDC noted. Also, reduced operation of syringe service programs (SSPs) and other health care clinics that provide hepatitis testing services and linkage to care for people at increased risk for HCV infection created new barriers to care.
The ongoing opioid crisis has led to a quadrupling of HCV infection rates from 2009 to 2019. Injection drug use was the leading risk factor for infection (67%) in 2019 and the greatest increase in HCV rates occurred among younger adults.
“Reaching more people with hepatitis C testing and treatment is critical to saving lives and preventing transmission of this deadly, but curable, infection,” the CDC noted. Despite the availability of curative treatment, an estimated 40% of people with HCV between 2015 and 2018 were unaware of their infection. The CDC recommends HCV screening for all adults and pregnant persons during every pregnancy and periodic testing for all people with risk factors.
Centers for Disease Control and Prevention. New estimates reveal declines in hepatitis C treatment in the US between 2015 and 2020. November 8, 2021. Accessed December 13, 2021. https://www.cdc.gov/nchhstp/newsroom/2021/2014-2020-hepatitis-c-treatment-estimates.html#Summary