Projected long-term impact of the COVID-19 pandemic on hepatitis C outcomes in the United States: a modelling study.

BACKGROUND: The COVID-19 pandemic disrupted access to and uptake of hepatitis C (HCV) care services in the U.S. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes. METHODS: We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12- and 24-months. RESULTS: Compared to the 'no pandemic' scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1,060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100,000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to 'no pandemic', the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR. CONCLUSIONS: A recommitment to the HCV epidemic in the U.S. that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.