HCV Testing and Treatment of Adults in the United States: 2014 Through 2021—Data From Two National Commercial Testing Laboratories

Abstract

Data on the hepatitis C virus (HCV) care cascade are crucial for determining if the United States (U.S.) is on track to meet 2016 World Health Organization elimination goals. De-identified data were analysed from persons who were screened for HCV antibody and/or tested for HCV RNA by two large U.S. commercial laboratories from 1/1/2014 to 12/31/2021. Validated imputation algorithms were used to identify persons who initiated treatment and who achieved virological cure based on viral load decline and continued negative HCV RNA test results. The 3-digit ZIP code was used to map treatment rates by U.S. state. During 1/1/2014 to 12/31/2021, a total of 46,646,661 persons were tested for HCV antibody of whom 2,253,500 (4.8%) were positive. Among 3,117,372 persons tested for HCV RNA, 1,951,742 (62.6%) were viremic. Cumulatively, a total of 672,745/1,951,742 (34.5%) viremic persons were treated; an estimated 643,043 (96%) were cured. Treatment rates increased with older age, higher fibrosis scores, HIV positivity, residing in an urban area and in the Northeast. Persons diagnosed by reflex testing had higher treatment rates. Comparing COVID-19 pandemic (2021) to pre-pandemic (2019) periods, 24% more HCV antibody tests were performed (10,167,524 vs. 7,727,318), but fewer persons were treated (21,136 vs. 26,124, 23% decline) and cured (19,584 vs. 24,480, 25.0% decline) in 2021, respectively. In 2021, primary care providers diagnosed and treated the greatest proportion of persons. Treatment uptake across the U.S. remains low, underscoring the need for additional measures to expand access to testing and treatment, necessary to reach the U.S. goals for HCV elimination by 2030.