Identification and Retrieval of Untreated HCV-Infected Individuals Lost to Follow-Up in Italy: Results From the RECALL Project

Background and Aims

Despite the availability of highly effective direct-acting antivirals, undiagnosed and untreated hepatitis C virus (HCV) infections remain a major obstacle to achieving WHO elimination targets. This study evaluated the feasibility and effectiveness of a local micro-elimination initiative aimed at identifying, retrieving and re-linking previously diagnosed but not treated individuals.

Methods

A retrospective analysis of anti-HCV test records from 2014 to 2020 in the AUSL Romagna area identified all individuals with a positive anti-HCV test and either confirmed or possible chronic HCV infection. Eligible cases were prospectively contacted first by phone, then by letter, and invited for clinical reassessment and antiviral therapy evaluation.

Results

Among 6859 individuals with a previous positive anti-HCV test, 2719 were identified as potentially viremic. Of these, 704 met eligibility criteria and were contacted. A total of 485 individuals were successfully reached (68.9%), 214 attended clinical reassessment and 160 were found to have active infection. Antiviral therapy was initiated in 127 patients (79.4%), with 100% achieving sustained virologic response. Advanced fibrosis or cirrhosis was present in 18.7%, and hepatobiliary malignancies were newly diagnosed in four patients.

Conclusions

This targeted retrieval strategy demonstrates that re-linkage of previously diagnosed HCV patients lost to follow-up is feasible and effective. Scaling up similar structured program could significantly contribute to national HCV elimination efforts by recovering hidden reservoirs of infection.