HCV microelimination strategies: An interventional study in diagnosed patients without access to the system

Abstract

Hepatitis C virus (HCV) one-step diagnosis improves recovery in patients with active infection. However, patients with previous anti-HCV+ may be excluded. We aimed to identify and retrieve non-referred or lost-to-follow-up HCV-infected patients. All anti-HCV+ patients seen in our hospital between 2013 and 2018 were included.In the first phase, we identified anti-HCV+ patients who were not referred to the Gastroenterology Unit (GU) or lost-to-follow-up. In the second phase, recovered patients were invited for a one-step visit for liver evaluation. A total of 1330 anti-HCV+ patients were included: 21.7% had not been referred to GU, and 23.1% were lostto-follow-up. In the second phase, 49.6% of patients were contacted, and 92.8% attended a medical consultation: 62.7% had active infection, 92.2% were treated, and 86.5% achieved SVR (ITT). We concluded that screening microbiological data and referring unidentified patients with active HCV infection directly to specialists is an effective tool in achieving HCV microelimination.

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

“…To achieve the goal set by the World Health Organization for HCV elimination, a diagnostic rate of 90% and a treatment coverage rate of 80% are required to achieve a 65% reduction in the rate of HCV-related deaths by 2030 [ 4 , 10 , 34 , 35 , 37 ]. A major challenge is determining the HCV genotype before initiating DAA regimens.…”

“…These agents have been reimbursed in Taiwan since 2017, and the government of Taiwan has set the goal of obtaining an 80% treatment coverage rate with DAAs by 2025 [ 1 , 7 , 8 , 9 ]. There are still several barriers to HCV elimination, such as the limitation of patient access to therapy, insufficient knowledge of HCV therapy, lack of awareness of the disease, and the complexity of treatment [ 4 , 10 , 11 , 12 ].…”

Implementation of a re‐linkage to care strategy in patients with chronic hepatitis C who were lost to follow‐up in Latin America

“…Kracht et al 9 designed a retrieval project through screening prior HCV positive tests in Utrecht, Netherlands, where authors found that 14% of chronic HCV were LTFU but only 43% of the patients were re‐linked to HCV care. A study from Seville, Spain, analysed the anti‐HCV positive test results at the Microbiology Unit 5 . Of the total anti‐HCV‐positive patients, 21% were never referred to a specialist, and of those who were referred, 23.1% were LTFU.…”

“…LTFU occurs in all steps of the care cascade and may severely affect clinical outcomes. Studies from different countries have shown that approximately 14%–61% of patients diagnosed with HCV infection are LTFU 5–9 . This is likely the consequence of the slow, silent and asymptomatic progression of the disease, and prior experience with interferon (IFN)‐based therapy that had considerable side effects and low sustained virological response (SVR) rates.…”

“…Thus, re‐linkage of those LTFU back into the HCV care cascade is an important step on the road towards HCV elimination. Several strategies have been performed, which have shown to be successful at retrieving a significant proportion of these patients to HCV care and proved to be a cost‐effective approach 5–10 …”