A Government-Led, Patient-Centric Strategy to Re-Engage Diagnosed but Untreated Hepatitis C Patients in Yunnan Province, China

Abstract

Diagnosed but untreated (DBU) hepatitis C virus (HCV) infected patients are a key group for HCV elimination efforts. This study aims to pilot a government-led, multi-sectoral approach to universal patient recall and treatment mobilisation in Yunnan Province, China, to determine if this approach can improve treatment uptake among DBU patients and contribute to HCV elimination. In this quasi-experimental before-and-after study, we analysed all hepatitis C cases reported from 2004 to 2021 in the Yuxi City Center for Disease Control (CDC) database. From July to December 2022, the traditional telephone recall model was used, and from July 2023 to January 2024, Yuxi CDC partnered with local stakeholders to implement a patient-centric strategy to re-engage DBU patients in care. We compared the outcomes between these two approaches. The cooperation model significantly improved HCV case management. The contact rate rose from 29.7% (645/2171) to 58.5% (3813/6520) (χ² = 25.743, p < 0.001); the HCV-RNA testing rate increased from 18.9% (122/645) to 86.1% (3283/3813) (χ² = 2760.164, p < 0.001); and treatment initiation for positive cases improved from 19.6% (9/46) to 57.8% (884/1530) (χ² = 26.555, p < 0.001). In total, 936 patients received treatment, and 92 patients (9.8%) were lost to follow-up 12 weeks post-treatment. Of the remaining 844 patients, 841 (99.6%) achieved SVR12 (sustained virological response12 weeks after therapy, defined as HCV quantitative test below 15 IU/mL), with no significant difference in outcomes between tested and untested genotype groups (χ² = 0.123, p = 0.725). This study highlights the substantial advantages of the cooperative model over the traditional approach, notably in contact, testing, and treatment rates, and successful SVR12 outcomes, underscoring the potential for such models in advancing HCV elimination.