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Hepatitis C micro-elimination through the retrieval strategy of patients lost to follow-up
Cheng-Jen Chen1, Yung-Hsin Huang1, Chao-Wei Hsu2,3
1Division of Hepato-Gastroenterology, Lin Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
Insights
A hospital call-back program successfully re-engaged patients with hepatitis C (HCV) who were lost to follow-up. This strategy effectively linked patients to care and treatment, aiding HCV elimination efforts.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- The World Health Organization aims to eliminate hepatitis C (HCV) by 2030.
- Patients diagnosed with HCV but lost to follow-up are a critical group for elimination strategies.
- A proactive call-back program was implemented to re-engage these patients.
Purpose of the Study:
- To retrieve and re-link patients with chronic HCV infection who were lost to follow-up.
- To analyze the effectiveness of a telephone-based retrieval strategy.
- To share experiences and improve HCV elimination strategies.
Main Methods:
- Retrieved a list of 31,275 anti-HCV Ab positive patients from 2004-2017.
- Reviewed electronic medical records to identify patients lost to follow-up.
- Contacted 11,934 patients via telephone, obtaining informed consent for treatment.
Main Results:
- 1277 eligible patients were identified for retrieval.
- Younger patients (<55), those in Taoyuan City, or tested in internal medicine had higher retrieval rates.
- 563 patients returned to care, 354 (62.9%) had HCV viremia, and 323 (91.2%) received direct-acting antiviral (DAA) treatment.
Conclusions:
- A call-back system is effective in reaching patients with chronic HCV infection who are unaware or have disengaged from care.
- This strategy successfully links patients to necessary treatment.
- The program contributes to HCV elimination goals by reconnecting patients to healthcare services.
Background And Aim:
World Health Organization sets up an ambitious and attainable goal to eliminate hepatitis C (HCV) by 2030. The previous diagnosed HCV patients lost to follow-up were considered as an important target group for HCV elimination. We conducted a call back program to retrieve the lost to follow-up HCV patients and link them to care in our hospital. By analyzing and comparing our result with that from other studies, we wish to improve our retrieval strategy and provide our experience to the general communities.
Methods:
A list of the patients with a medical record showing seropositive for antibody to HCV (anti-HCV Ab) from 2004 to 2017 was retrieved by the department of intelligent technology of our hospital. Three dedicated staff members reviewed the patients' electronic medical records (EMRs) and recruited the patient lost follow-up to the call back program. The staff members contacted the qualified patients by telephone and inquired about their opinions for treating their chronic HCV infection. We also informed the patients about the retrieval strategy and why we contact them. As our National Health Insurance request, we gave all patient one informed consent for hepatitis C treatment. Informed consents have been obtained from all patients. Referrals to our gastroenterology unit (GU) were arranged for the patients who would like to continue their chronic HCV care in our hospital.
Results:
There were 31,275 anti-HCV positive patients. We included 11,934 patients (38.2%) into the call back system and contacted them by telephone. Based on the response to our call, we ascertained 1277 eligible cases (10.7%) for retrieval. The patients who were younger (< 55), lived in Taoyaun City or had tested positive for anti-HCV Ab at the department of internal medicine department had an increased rate of successful call back. There were 563 patients (44.1%) returning to our GU. Of them, 354 patients (62.9%) were positive for HCV viremia. 323 patients (91.2%) received the DAAs treatment. The SVR12 with Grazoprevir + elbasvir, Glecaprevir + pibrentasvir, Sofosbuvir + ledipasvir and Sofosbuvir + velpatasvir were 97.9%, 98.8%, 100% and 97.5%, respectively.
Conclusions:
Call back system can expand our reach to those unaware or ignoring chronic HCV infection patients and link them to treatment.
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