Introduction The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus (HCV) antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed HCV during the pandemic may later become identified at more advanced stages of the disease, leading to higher rates of morbidity and mortality rates. Further, unidentified HCV-infected individuals may continue to unknowingly transmit the virus to others. Methods To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and national estimates of dispensed prescriptions for HCV treatment. Investigators estimated the average number of HCV antibody tests, HCV antibody positive test results, and HCV RNA positive test results by month, January–July for 2018/2019, compared with the same months in 2020. To assess the impact of HCV treatment, dispensed HCV direct acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models. Results Compared with the 2018/2019 months, HCV antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July. The number of HCV RNA positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. For HCV treatment, prescriptions decreased 43% in May, 37% in June, and 38% July relative to corresponding months in 2018/2019. Conclusions During the COVID-19 pandemic, continued public health messaging, interventions and outreach programs to restore HCV testing and treatment to pre-pandemic levels, and maintenance of public health efforts to eliminate hepatitis C infections remain important.

Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross‐sectional analysis of 72 745 GHS patients who received anti‐HCV testing from 2004 to 2016. We created a testing cascade: (1) anti‐HCV reactive, (2) HCV RNA tested and (3) HCV RNA detectable; and a cure cascade: (1) HCV RNA detectable, (2) engaged in care, (3) treatment prescribed, (4) sustained virologic response (SVR) tested and (5) SVR documented. A total of 9893 (14%) had reactive anti‐HCV tests of 72 745 patients tested, 5109 (52%) of these had HCV RNA tested, and 4224 (43%) were HCV RNA detectable. A total of 2738 (65%) of 4224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, using EHR data, we identified high anti‐HCV prevalence and noted gaps in HCV RNA testing, linkage to care and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps.

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