Hepatitis C Elimination During a Global Pandemic: A Case Study of Resilience in Action

Abstract

Until the COVID-19 pandemic, San Francisco’s hepatitis C virus (HCV) elimination initiative, End Hep C SF, was expanding and refining HCV testing and treatment strategies citywide, making progress toward local HCV elimination goals. Although a shelter-in-place health order issued in March 2020 categorized HCV testing as an “essential service,” most HCV testing and treatment immediately stopped until COVID-19–safe protocols could be implemented. During the 14 months of pandemic-related organizational closures, End Hep C SF transitioned to a 100% virtual model, maintaining regularly scheduled meetings. Community-based HCV antibody testing decreased 80% from February to April 2020, and HCV treatment initiation also decreased, although both services started to rebound in mid-to-late 2020, partially as a result of End Hep C SF collaborations. End Hep C SF service providers, clinicians, and advocates reported that the continuous communication and common agenda of End Hep C SF—2 principles of the collective impact initiative—served as a familiar touchpoint and helpful source of information during this isolating and uncertain time. Ultimately, End Hep C SF allowed us to continue HCV elimination strategies through 6 lessons learned: maintaining HCV treatment access through telehealth and mobile services; leveraging research studies that provided HCV testing and treatment; offering HCV screening and linkage to care in tandem with COVID-19–related initiatives; being flexible and inventive, such as administering HCV treatment to residents of shelter-in-place hotels; establishing a data dashboard to track HCV testing and treatment; and relying on partnerships to solve problems and avoid burnout.

Epidemiological Modeling of the Impact of Public Health Policies on Hepatitis C: Protocol for a Gamification Tool Targeting Microelimination

“…Similarly, as stated in the appointed application articles for this model [ 38 - 42 ], although there were differences in the year of elimination of hepatitis C (according to WHO criteria), these were not structural until the COVID-19 pandemic. It must be noted that COVID-19 represents a threat to allocated efforts to achieve the elimination of hepatitis C by 2030, with the disease elimination programs being highly impacted [ 43 - 45 ]. In addition, the results that were different were essentially because of distinct assumptions regarding the implementation intensity of PHPs, which points toward an interesting concurrent validity.…”

Hepatitis C prevalence and key population size estimate updates in San Francisco: 2015 to 2019

“…Importantly, this estimate focuses on data through 2019, before the impacts of the COVID-19 pandemic were realized; some research has already demonstrated a likely negative impact on the prevention, diagnosis, and treatment of HCV in San Francisco [ 53 ] and other regions [ 54 , 55 ]. Regardless, as San Francisco continues to strive toward HCV elimination through End Hep C SF , estimates of the remaining number of people with untreated active infection are an important measure of progress.…”

Epidemiological Modeling of the Impact of Public Health Policies on Hepatitis C: Protocol for a Gamification Tool Targeting Microelimination (Preprint)

“…Similarly, as stated in the appointed application articles for this model [38][39][40][41][42], although there were differences in the year of elimination of hepatitis C (according to WHO criteria), these were not structural until the COVID-19 pandemic. It must be noted that COVID-19 represents a threat to allocated efforts to achieve the elimination of hepatitis C by 2030, with the disease elimination programs being highly impacted [43][44][45]. In addition, the results that were different were essentially because of distinct assumptions regarding the implementation intensity of PHPs, which points toward an interesting concurrent validity.…”