June 26, 2020 HEALTH AFFAIRS BLOG 10.1377/hblog20200624.8487510.1377/hblog20200624.84875
Impact Of COVID-19 Response On Other Necessary Public Health ServicesIn a a recent survey of health department sexually transmitted disease (STD) programs, more than half reported negative impacts of the COVID-19 response on the provision of recommended screening, diagnostic, and treatment services. Decreases in the availability of syringe service programs and limitations in access to pre-exposure prophylaxis (PrEP) for HIV have also been reported as a consequence of shifting resources and changing priorities in response to COVID-19. Not surprisingly, viral hepatitis prevention and control programs have also experienced this strain.
In May 2020, the National Alliance of State and Territorial AIDS Directors (NASTAD) conducted a request for information (RFI), asking the viral hepatitis and HIV prevention and care staff of health departments to provide specific details about the impact of the COVID 19 pandemic on public health capacity. The organization found that over 80% of hepatitis program, 75% of HIV prevention program, and 57% of Ryan White HIV/AIDS program staff at health departments reported being detailed to the COVID 19 response. In light of current circumstances, over 90% of the hepatitis programs responding to the RFI indicated that they anticipate reductions in viral hepatitis outreach, education, testing, and linkage to care services.
Effect On Viral Hepatitis Elimination EffortsWhile no public health leader questions the need to respond to SARS-CoV-2 with deliberate speed and appropriate action, the COVID-19 pandemic has emerged at a particularly critical time in America’s effort to eliminate hepatitis C in the United States. Consider the situation in Louisiana. In June 2019, the state announced the creation of an innovative payment model for hepatitis C treatment that would enable it to provide curative therapy for two vulnerable populations disproportionately affected by hepatitis C: persons on Medicaid and those receiving care through the state corrections system. Prior to the program’s launch, approximately 61 persons per month were started on curative treatment for hepatitis C virus (HCV) in state Medicaid and Department of Corrections programs. After a successful implementation, this figure increased dramatically to some 478 persons per month being treated. However, due to disruptions brought on by the COVID-19 pandemic, the number of new treatment starts dropped to 155 persons in Spring 2020 (mid-March to mid-April). And given constraints in state budgets anticipated in the face of COVID-19 response, other jurisdictions may be slowed or even halted in their efforts to launch viral hepatitis elimination programs.
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