Impact of COVID-19 on Hepatitis B Testing in British Columbia, Canada
Overview
The COVID-19 pandemic led to significant reductions in hepatitis B virus (HBV) testing in British Columbia, Canada, particularly for HBV surface antigen (HBsAg) and HBV DNA tests. Testing rates remained below predicted levels throughout 2021 and 2022, with greater reductions observed among people who inject drugs (PWID).
Background
Hepatitis B infection affects millions globally and remains a major cause of morbidity despite available vaccines and treatments. Canada aims to eliminate HBV as a public health threat by 2030, but the COVID-19 pandemic disrupted healthcare services, complicating these efforts. Universal HBV testing is recommended for pregnant women and high-risk groups, including PWID, who are disproportionately affected by HBV and the pandemic. Understanding the pandemic's impact on HBV testing is critical for guiding public health interventions.
Data Highlights
Test Type
Period
Reduction vs Predicted (%)
95% Confidence Interval (%)
PWID Reduction (%)
Non-PWID Reduction (%)
HBsAg
June–Dec 2020
16.5
13.9–18.9
Not specified
Not specified
HBV DNA
June–Dec 2020
11.6
9.5–13.6
30.0
11.2
HBV DNA
2021 and 2022
Lower than predicted
Not specified
Greater reductions in PWID vs non-PWID
Lower reductions
HBeAg
Overall
Less pronounced changes
Varied by sex and age
Not specified
Not specified
Key Findings
HBsAg testing decreased by 16.5% during June–December 2020 compared to predicted levels.
HBV DNA testing decreased by 11.6% in the same period, with a 30% reduction among PWID versus 11.2% among non-PWID.
Testing rates for both HBsAg and HBV DNA remained below predicted levels throughout 2021 and 2022.
Changes in HBeAg testing were less pronounced overall but varied by sex and age groups.
The COVID-19 pandemic and related public health policies significantly disrupted HBV testing services in BC.
PWID, a high-risk group for HBV, experienced disproportionately greater reductions in HBV DNA testing.
Clinical Implications
Healthcare providers should be aware of the sustained reductions in HBV testing caused by the COVID-19 pandemic, especially among high-risk populations such as PWID. Efforts to increase HBV testing and ensure linkage to care are essential to meet elimination targets and prevent HBV-related morbidity. Tailored strategies may be needed to address barriers faced by PWID and other vulnerable groups.
Conclusion
The COVID-19 pandemic led to significant and sustained decreases in HBV testing in British Columbia, with disproportionate impacts on PWID. Addressing these gaps is critical to advancing HBV elimination goals.
References
BC COVID-19 Cohort Study -- Effects of the COVID-19 Pandemic on Hepatitis B Testing in British Columbia, Canada
by Richard L Morrow, Jean D Makuza, Dahn Jeong, Mike Irvine, Beate Sander, William W L Wong, Yeva Sahakyan, Zoë Greenwald, Hin Hin Ko, Héctor A Velásquez García, Sofia R Bartlett, Jason Wong, Amanda Yu, Mel Krajden, Alnoor Ramji, Ji Hyun Choi, Julia Li, Stanley Wong, Naveed Zafar Janjua
