Due to the COVID-19 pandemic, hepatitis C virus (HCV) treatment in the U.S. reduced by 30% in March 2020 and remained low throughout the end of 2020, but the impact on HCV elimination is unknown. We use modeling to estimate the impact of the COVID-19 pandemic on the likelihood of reaching the World Health Organization (WHO) and U.S. National Academies of Sciences and Engineering (NASEM) HCV elimination targets by 2030 (80% reduction in HCV incidence, 65% reduction in HCV mortality from a 2015 baseline).
We developed a general population model that simulates HCV transmission and progression in the U.S. The model is stratified by age and risk (young adult (20-30 years) non PWID, young adult (20-30 years) PWID, adults (31-51 years), and older adults (? 52 years)), HCV disease stage, diagnosis, and treatment status. The model was calibrated to data from the literature on number of chronic infections in 2011 and 2018, number aware of their infection and number cured in 2018. The model was validated against U.S. Centers for Diseases Control estimates of new HCV infections in 2019. We used the calibrated model to simulate the impact on HCV incidence and HCV-related mortality from 2015-2030 with: (1) no disruption to treatment uptake from 2020 onwards; (2) 1-year reduction in treatment (by 30%) from 2020 (as observed in national data), and (3) 2-year reduction in treatment (by 30%) followed by return to status quo.
We estimated there were 67,267 (95%CI 23,433-114,471) new HCV infections in 2015. Under all scenarios the 80% incidence reduction target is missed (29.7% reduction by 2030 even with no disruption to treatment, even less impact with COVID disruptions). There are overall 990 (95% 417-1,330) additional new infections from 2015-2030 for the 1 year disruption, and 1,933 (95% 800-2,599) additional new infections for the 2 year disruption. Similarly, all projections fail to meet the mortality target by 2030, with an anticipated relative reduction in mortality of 30.6% (95% 21.7-38.4%) with a 1 year disruption.
The U.S. was not on track to achieve the WHO and U.S. NASEM elimination targets pre-pandemic and has fallen further behind during the COVID-19 pandemic. Urgent scale-up of HCV diagnosis, treatment, and prevention is required.