Impact of the COVID-19 pandemic on hepatitis C care across the cascade of care: a scoping review

Background: The COVID-19 pandemic was associated with widespread health services disruption, including challenges in the management of chronic infectious diseases. However, evidence regarding reported changes in hepatitis C virus (HCV) care during this period remains limited and fragmented. We aimed to map the available evidence on reported changes in HCV care during the COVID-19 pandemic across the HCV cascade of care. 

Method: We conducted a scoping review following the Arksey and O’Malley methodological framework. Searches of Medline (PubMed), Cochrane Library, Embase, Scopus, Web of Science, and grey literature identified studies reporting pandemic-related changes in HCV diagnosis, linkage to care, treatment, or cure from; March 2020 to March 2025. Data were extracted on the study setting, stage of the cascade of care, and observed changes in HCV care, and synthesized narratively.

Results: Twenty-eight studies met the inclusion criteria. Eighteen were conducted in Europe and North America. Most studies found declines in HCV care across all stages of the cascade of care: diagnosis (15 of 21 studies), linkage to care (9 of 10), treatment initiation or completion (18 of 27), and cure (6 of 13). Among the included studies, linkage to care was the stage most consistently reported as disrupted. 

Conclusion: Evidence on reported changes in the HCV cascade of care during the COVID-19 pandemic is limited and geographically skewed toward high-income countries. Available data suggest service reductions across all stages, with linkage to care being the stage most frequently reported as disrupted among the studies that assessed it. Strengthening surveillance, ensuring routine monitoring at all stages of the cascade of care, and building resilient HCV services are critical to safeguarding progress toward the 2030 hepatitis elimination goal.