Before the COVID-19 pandemic, San Francisco was on the brink of an incredible feat: the city was close to achieving a goal set by the World Health Organization to reduce the incidence of chronic hepatitis C cases by 80 percent by 2030. In fact, San Francisco was more than four years ahead of schedule. Reaching this milestone would make San Francisco one step closer to eliminating hepatitis C, something that has only become possible in the past decade with the invention of a breakthrough class of medications called direct-acting antivirals which can cure the disease.
Yet the pandemic quickly threatened to unravel all progress. “During the pandemic, hepatitis C testing in many places paused because it was not considered an essential service,” said Meghan Morris, PhD, MPH, an associate professor of epidemiology and biostatistics at the UCSF Department of Epidemiology and Biostatistics. “[It was the] same with hepatitis C treatment.”
Morris and a modeling team in Bristol, United Kingdom, recently published a new study that quantified the impact of the pandemic on progress towards hepatitis C elimination goals and what the city can do to get back on track. They looked specifically at hepatitis C elimination in people who use drugs, which is the population with the highest burden of disease in San Francisco. Many of these people also experience homelessness.
The study, published on June 22 in the International Journal of Drug Policy, found that if the pandemic had never happened, San Francisco would have had a 96 percent chance of meeting its hepatitis C elimination goals by 2030. However, if San Francisco continues its current course of action, there is only a 62 percent chance that the city will meet its goal on time.
Luckily, Morris said, there are things that the city can do to get closer to 96 percent again, which would effectively erase the impact of COVID-19. The modeling found that if homeless people who use drugs are given stable housing and more hepatitis C testing and treatment, San Francisco can once again approach a 96 percent probability of meeting its 2030 elimination goal.
Morris works closely with End Hep C SF,
Jordan Akerley, the strategic director at End Hep C SF, says this study comes at a crucial political time in San Francisco. “The environment we’re in right now is subject to rapid change,” Akerley said, citing the recent Grants Pass v. Johnson ruling by the Supreme Court in June that allows city governments to criminalize people who sleep on the streets. These changes threaten to destabilize systems of care right when stability is needed the most, Akerley said.
Morris’ findings echo the need for people to have safe, stable housing in order to eliminate hepatitis C. “If we just focus on testing and treatment, that’s not going to get us there,” Morris said. “If you don’t have stability of where you sleep or eat, it will be much harder to navigate completing your hepatitis C treatment. Housing is key for health.”
Authors: Additional DEB authors include Sheena Patel, Erin Wilson, DrPH, MPH and Willi McFarland, MD, PhD, MPH