Abstract / Summary
The impact of the COVID-19 pandemic and related public health measures on hepatitis C (HCV) treatment uptake in Ontario remains uncertain. We evaluated changes in HCV treatment initiation during the pandemic overall and among priority populations. We conducted a population-based study using Ontario health administrative data from January 2015 to December 2022. The primary outcome was HCV treatment initiation rate, defined as the first antiviral dispensation per 1000 eligible individuals. Interrupted time series analysis estimated changes during the pandemic relative to counterfactual projections based on pre-pandemic trends. We stratified analyses by birth cohort, immigration status, homelessness, people who inject drugs (PWID), and human immunodeficiency virus status. A sensitivity analysis restricted the pre-pandemic period to 2018 onward. Among 63,691 eligible individuals, treatment initiation increased from 2015, peaked in 2017, and declined thereafter, resulting in a flat pre-pandemic trend. Treatment initiation declined at pandemic onset and continued downward through 2022; however, neither level nor slope changes were statistically significant. Results were sensitive to pre-pandemic period specification: restricting analyses to 2018 onward showed a significant pre-pandemic decline, with observed pandemic-period rates exceeding counterfactual projections. Younger cohorts, PWID, and individuals experiencing homelessness showed heterogeneous trends. We found no clear evidence that the COVID-19 pandemic independently altered HCV treatment initiation trends in Ontario, although treatment initiation declined at pandemic onset and remained lower throughout the pandemic period.