Dip in hepatitis testing adds to ‘interrupted’ health progress

The number of hepatitis serology tests declined by 19% during April–December 2020 compared to the same period in 2019. And there were 227,000 fewer tests performed in 2020 compared to the previous year, representing an estimated 176,000 fewer individuals receiving testing.
 
Doherty Institute WHO Collaborating Centre for Viral Hepatitis epidemiologist, Jennifer MacLachlan, believes that lower rates of hepatitis diagnosis and management will have flow-on impacts, particularly on progress toward national strategy targets.
 
Further declines in hepatitis C monitoring could also lead to more rapid decreases in treatment uptake, which need to remain stable in order to reach national targets.
 
In a presentation at ASHM’s recent Australasian Viral Hepatitis Conference, Ms MacLachlan said these figures of decline are a symbol of the ‘interrupted progress’ that has eventuated due to COVID-19.
 
‘COVID-19 and the associated health service interruptions had substantial negative impact on the uptake of screening, as well as to the management and work-up for viral hepatitis,’ she said.
 
‘At the end of 2019 there was an increased need for hepatitis B diagnosis and care which necessitates screening and an increase of testing, and also the need for continued hepatitis C treatment in order to reach the targets.’
 
Ms MacLachlan’s analysis aims to assess what impact COVID-related public health restrictions, such as lockdowns, have had on service delivery by comparing 2020 numbers with 2019.

‘From the number of hepatitis B tests that were done through Medicare from 2017 through to the end of 2020 … we can see the beginning of significant disruption due to COVID-19 in April and May 2020, and the very rapid decline in the number of tests occurring,’ she said.
 
More than 300,000 fewer tests were conducted in 2020 compared to 2019, which represented a 14% decline in Medicare serology items, compared to an approximately 5% increase between 2018 and 2019.
 
These figures show the need to ‘substantially’ increase the number of screening tests to improve diagnosis, according to Ms MacLachlan.
 
To date, 2021 has seen a distinct increase in testing in the early months.
 
‘This is really promising, but the total number of tests is still lower than what it would have been in 2019, and not yet making up for the number of tests that were missed during 2020,’ Ms MacLachlan said.
 
Dr Susan Matthews, Deputy Director at Flinders University International Centre for Point-of-Care Testing, believes that hepatitis C elimination can be achieved with effective models of care.
 
Using findings from Australian point-of-care testing networks to inform scale-up of hepatitis C ribonucleic acid (RNA) testing, Dr Matthews said in her presentation at the ASHM conference that targeted, multidisciplinary, affordable and patient-centred models of care are required.
 
‘We would like to simplify testing, treatment delivery and monitoring for hepatitis C, and we can do this by single-visit test and treatment models, where we have reduced turnaround time for diagnosis,’ she said.
 
‘This is facilitated through the pan-genotypic point-of-care hepatitis C RNA tests … and also the fact that we have good safety regimes that allow RNA to be used, perhaps at zero and three months to monitor treatment effectiveness.’
 
The single-visit tests for hepatitis C have high treatment uptake, Dr Matthews said.
 
‘Our studies show a 77% uptake in a needle syringe program and 95% in prisons, versus a 26% uptake with usual standard of care,’ she said.
 
‘Modelling also shows us that to reach our World Health Organisation (WHO) elimination targets for hepatitis C, we need to increase our RNA testing by about 50%.’
 
Dr Matthews says the GeneXpert hepatitis C viral load fingerstick test – approved by the Therapeutic Goods Administration in 2020 – offers rapid, single-visit treatment assessment and delivery, particularly in high-risk populations.

‘The results of both RNA-detecting hepatitis C and quantification, are available within 58 minutes,’ she said.
 
‘This is a gold standard, real-time PCR method that detects genotypes one to six … with the intended use to aid the diagnosis of active hepatitis C infection.’
 
With a growing uptake of point-of-care testing, both Dr Matthews and Ms MacLachlan agree that further investigation of individual-level data, clinical patterns and continued tracking of the impacts and improvements of hepatitis C testing, during COVID and beyond, is imperative.
 
‘The impacts of [the decrease in testing] could be seen for a considerable length of time,’ Ms MacLachlan said.
 
‘Routinely collected data … can provide really rapid assessment to public health action and this demonstrates the need for engagement of people living with or at risk of hepatitis post-COVID.’
 
Ongoing public health messaging, interventions and outreach programs to restore hepatitis C testing and treatment to pre-pandemic levels, as well as maintaining efforts to eliminate infections remain a focus, according to Dr Matthews.
 
‘We need to take stock of where we are, and also how we’re going to innovate in the future,’ she said.
 
‘To reach our ambitious goals of eliminating hepatitis C as a public health threat by 2030, especially.’
 
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COVID-19 hepatitis point-of-care testing RNA serology