Striving toward hepatitis C elimination in the era of COVID-19

To the Editor:

Governments worldwide have committed to achieving the World Health Organization (WHO) targets to eliminate the hepatitis C virus (HCV) as a public health threat by 2030 (1). Although recent modelling studies suggest that some countries, including Canada, are on track to eliminate HCV, they could not account for the emergence of the coronavirus disease 2019 (COVID-19) pandemic, which may jeopardize progress toward elimination (2, 3).

The pandemic has had an impact on all stages of the HCV care cascade and has reduced access to essential medical services among priority populations (ie, people disproportionately affected by HCV), including people who use drugs (4). Although governments are rightfully focused on controlling transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), marginalized populations struggle to maintain access to harm reduction and drug treatment services (5–8). Beyond interfering with HCV elimination efforts, the pandemic may, through increased inequity and changes to social service and community support structures, exacerbate existing challenges faced by these groups, including stigma and discrimination, overdose risk, comorbidities, poverty, precarious housing, and domestic violence (9–12). Recent increases in overdose-related deaths in North America reflect this reality (13–15).

The massive mobilization for COVID-19 prevention and testing has enabled the control of SARS-CoV-2 transmission in many settings and has demonstrated the feasibility of rapid and widespread public health action. Factoring in the risk of COVID-19 re-emergence (16), we must build on these lessons to counteract growing health care inequities among marginalized populations and promote a holistic approach to care. We need innovative, person-centred, and culturally sensitive approaches to ensure access to harm reduction services and to prevent HCV (re-)infection and other drug-related harms. By mirroring models implemented to test for SARS-CoV-2 and by co-locating services for HCV and COVID-19 surveillance and care, we can simultaneously reduce the consequences of both viruses in our communities (17). For example, HCV testing and treatment can be further scaled up by offering self-collected dried blood spot testing and telemedicine. Remote testing, embedded with a supportive care pathway, respects autonomy and privacy (18). Telemedicine can produce favourable HCV outcomes and has seen widespread adoption during the pandemic (19). Rapid implementation of these models can ensure that the SARS-CoV-2 pandemic does not lead to setbacks in achieving HCV elimination goals.

The WHO’s HCV elimination targets are ambitious and require continuing efforts by committed governments to address the intersectional issues faced by priority populations. The COVID-19 pandemic has further marginalized the most underserved in our communities, yet it has demonstrated that concentrated action can minimize infectious disease transmission. These lessons should be applied in the context of hepatitis C as we continue to strive toward elimination.

Funding:

All authors received trainee fellowships from the Canadian Network on Hepatitis C: CIAO, SD, MR, and AP received master’s fellowships; CLD, ZRG, NM, DJ, GM, YAS, RDK, HLW, AM, C-HL, SM, MAP, and MNA received doctoral fellowships; and AAA, GK, CTP, and EBC received a post-doctoral fellowship. The Canadian Network on Hepatitis C is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada. CLD received a doctoral training award from the Fonds de Recherche du Québec – Santé (FRQ-S). ZRG received an Ontario graduate scholarship. NM received an FRQ-S doctoral research award. AAA is supported though postdoctoral fellowships from the CIHR and the FRQ-S. DJ received a Frederick Banting and Charles Best Doctoral Award from the CIHR. HLW received a Memorial University Faculty of Medicine Dean's Fellowship (MSc and PhD), the Memorial University School of Graduate Studies Aldrich Award, and a CIHR Banting and Best Canada Graduate Scholarship–Masters. MAP received a doctoral scholarship from the Natural Sciences and Engineering Research Council of Canada and a College of Medicine Graduate Student Award from the University of Saskatchewan. AP received a master’s scholarship from the FRQ-S.

Disclosures:

The authors have no conflict of interest to disclose.