Reconnecting hepatitis C patients lost to follow-up ‒A targeted strategy.

Abstract

Background: Hepatitis C virus (HCV) infection remains a major contributor to liver-related morbidity and mortality worldwide. Although direct-acting antivirals (DAAs) achieve cure rates exceeding 95%, a substantial fraction of diagnosed patients never link to care.

Objectives: To evaluate the effectiveness of a dual-modality retrieval strategy-mailed invitations followed by telephone outreach-in re-linking HCV-diagnosed patients lost to the health system within a defined health area.

Methods: From 2010 to 2018, 4,816 anti-HCV serologies were reviewed and 677 patients (449 anti-HCV positive; 228 HCV RNA positive) were identified as lost to follow-up. An administrative team sent 436 personalized letters inviting patients to contact a dedicated phone line, then placed up to three calls (n = 363) to nonresponders during varied days and times. Respondents were offered expedited hepatology consultation (diagnostic confirmation, fibrosis staging) and DAA therapy.

Results: Of 436 patients contacted, 260 (60%) responded (28% via letter and 72% via phone). Among these, 119 (47%) enrolled in follow-up (exclusion reasons: 65 declined further care, 51 were already treated/cured elsewhere, 13 had relocated, and 12 were deceased). A total of 119 patients attended hepatology consultation and underwent HCV RNA testing; 66 (55%, 66/119) initiated DAAs and all achieved sustained virological response at 12 weeks post-therapy completion, representing 10% of the original cohort, and 25% of contacts.

Conclusions: Active retrieval combining mailed invitations and telephone outreach effectively re-links lost HCV patients to care, enabling DAA treatment and supporting national elimination goals.