Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus

Abstract

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Loss to follow‐up in the hepatitis C care cascade: A substantial problem but opportunity for micro‐elimination

“…It is reasonable to assume that data from the interferon era on LTFU are worse, due to the fact that fewer patients had an indication for treatment, more patients refused treatment, fewer patients finished the ill‐tolerated treatment and only a limited number of patients achieved cure, compared to the DAA era. This hypothesis was confirmed in a recent study by Aleman et al 19 The authors included HCV patients from their national register diagnosed between 2001 and 2011 and alive in 2013, and found that an impressive 61% was LTFU. A study from Belgium using a similar approach showed that PWID and patients who never received HCV treatment had a higher risk of becoming LTFU (OR 2.2 for both) 20 .…”

“…Suppl file [12][13][14][15][16][17] Other studies that reviewed ever-diagnosed patients defined LTFU as patients who never or not recently had an appointment with an HCV specialist. Suppl file 18,19 Interventional studies aiming to improve the cascade of care also do not give a definition or define LTFU as nonattendance anywhere in the care cascade, Suppl file often separating death from the LTFU group. Suppl file 50-58 There are some studies that include multiple LTFU definitions and report data on all of them, such as nonattendance, nonresponse to invitation, moved, incarcerated, no insurance and comorbidities.…”

“…However, attendance to this follow-up visit is only reported in 27%-91% (median 68%) of cases. Suppl file 1, [18][19][20][21][22][25][26][27][28]52,59,60 People who inject(ed) drugs (PWID), a well-known hard to reach population, attend in 36%-65% of cases (median 50%). Suppl file [29][30][31][32] In HIV/HCV-coinfected patients, attendance seems to be higher with 25%-95% (median 90%).…”

“…Suppl file 1-5,13,34 Interventional studies aimed to improve the care cascade show that this rate can increase to 16%-100% (median 73%). Suppl file [18][19][20][21][22][23][24][25][26][27][28]33,[35][36][37][38][39][50][51][52][53][59][60][61][62] Studies in the HIV field show similar results, with 36%-91% (median 90%) initiating treatment in retrospective studies Suppl file 9-11 and 25%-100% (median 80%) in interventional studies. Suppl file 47-49 However, the treatment rate remains suboptimal in PWID with only 20%-90% (median 53%) initiating treatment.…”

High prevalence of unawareness of HCV infection status among both HCV-seronegative and seropositive people living with human immunodeficiency virus in Taiwan

“…The global seroprevalence of the hepatitis C virus (HCV) is approximately 2.5% [ 1 ]. Although treatment with direct-acting antivirals (DAAs) can lead to the elimination of HCV viremia and a curative outcome in more than 90% of patients with chronic HCV infection [ 2 ], several barriers to eradicating HCV infection still exist, including the high costs of drugs [ 3 ], frequent loss to follow-up after diagnosis [ 4 ], high rate of early HCV reinfection among patients who have recently received drug injections [ 5 ], and ongoing high-risk behaviors associated with HCV infection (even after clearance of HCV infection) [ 6 ]. The identification of undiagnosed patients, timely provision of DAAs to HCV-seropositive populations [ 7 , 8 ], and the prevention of transmission among at-risk HCV-seronegative populations must be prioritized to eliminate HCV infection [ 7 ].…”