Relink Programmes: Impact of Reengagement on Linkage to Care Across 82 006 People With Hepatitis C

Abstract

Background and Aims

A major barrier to hepatitis C virus (HCV) elimination is the failure to ensure that individuals complete the HCV care cascade after they test positive for HCV RNA and/or antibody. Microelimination programmes support protocols that reengage patients with care/treatment. We describe 18 microelimination programmes aimed at identifying persons who were diagnosed but untreated/not cured and reconnecting them to care. Here, we report the programmes' effectiveness, identify key challenges and suggest best practices for future initiatives.

Methods

Pooled and individual programme data (available as of 31 January 2024) were assessed. Each programme had a retrospective phase in which medical/laboratory records were searched within a specified date range for patients who were positive for HCV antibody and/or RNA at last testing. In a prospective phase, programmes attempted to reengage these patients with care.

Results

Across the 18 programmes worldwide, 82 006 individuals were identified as eligible for follow-up. Overall, 21 235 people were selected for attempted contact, and 5308 were relinked to care. In 17 programmes reporting treatment data, 51% (1513 of 2976) of relinked patients initiated treatment. Four programmes used innovative care models and achieved treatment initiation rates ≥ 80%. Amongst patients with results available, 89% (643 of 722) who initiated treatment achieved HCV cure. Challenges included the inability to contact people and missed appointments.

Conclusion

Systematic screening of medical/laboratory records was effective in identifying patients who had been lost to follow-up, and the use of innovative care models, such as test-and-treat or decentralised approaches, resulted in higher treatment numbers.