Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

Cori Campbell,William Gelson,Josune Olza,Vince Taylor,Kerrie Woods,Gail Roadknight,David Ramlakhan,Hizni Salih,Jim Davies,Eleanor Barnes,Paul Klenerman,Steve Harris,Tingyan Wang,Ben Glampson,Jane Collier,Luis Romão,Luca Mercuri,Frazer Warricker,Oliver Freeman,Eleni Nastouli,Kinga A Várnai,Theresa Noble,Florina Borca,Salim I Khakoo,Monique Andersson ,Afzal Chaudhry ,Hang Phan ,Christopher R Jones ,Louise English ,Dimitri Papadimitriou ,David A Smith ,Stephanie Little ,Graham Cooke ,Philippa C Matthews

doi:10.12688/wellcomeopenres.17522.1

Abstract

Background: To determine the impact of the COVID-19 pandemic on the population with chronic Hepatitis B virus (HBV) infection under hospital follow-up in the UK, we quantified the coverage and frequency of measurements of biomarkers used for routine surveillance (alanine transferase [ALT] and HBV viral load). Methods: We used anonymized electronic health record data from the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC) pipeline representing five UK National Health Service (NHS) Trusts. Results: We report significant reductions in surveillance of both biomarkers during the pandemic compared to pre-COVID-19 years, both in terms of the proportion of patients who had ≥1 measurement annually, and the mean number of measurements per patient. Conclusions: These results demonstrate the real-time utility of HIC data in monitoring health-care provision, and support interventions to provide catch-up services to minimise the impact of the pandemic. Further investigation is required to determine whether these disruptions will be associated with increased rates of adverse chronic HBV outcomes.

Highlights

Mortality and morbidity associated with the Coronavirus Disease 2019 (COVID-19) pandemic can be directly attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and result from indirect impacts on other conditions
We undertook longitudinal and cross-sectional analyses using routinely-collected individual-level secondary care data collected across five National Health Service (NHS) Trusts in England by the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC), as previously described[9,10]
We investigated how ALT and viral load (VL) surveillance varied between pre-COVID-19 to COVID-19, comparing surveillance metrics in patients on and off antiviral therapy

Summary

Introduction

Mortality and morbidity associated with the Coronavirus Disease 2019 (COVID-19) pandemic can be directly attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and result from indirect impacts on other conditions. In order to progress towards elimination targets for Hepatitis B virus (HBV) infection[1] there is an urgent need for improvement of surveillance and treatment coverage This will necessitate enhanced screening, followed by surveillance of individuals with chronic HBV (CHB) to determine treatment eligibility. Clinical follow-up includes routine monitoring of liver enzymes (e.g., alanine transferase (ALT)), hepatitis B virus (HBV) DNA viral load (VL), elastography, ultrasound, and occasionally liver biopsy[2,3,4]. In those receiving antiviral treatment, laboratory parameters are monitored to ensure virologic suppression is achieved and maintained, and to identify complications. COVID-19-attributable disruptions to HBV elimination efforts have been broadly described[7,8], but we set out to quantify the specific impact on routine HBV surveillance in secondary care services in England using individual-level patient data

Methods

Results

National Institute for Health and Care Excellence

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