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

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 health care.

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

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 made up to three calls (n = 363) to non-responders during varied days and times. Respondents were offered expedited Hepatology consultation (diagnostic confirmation, fibrosis staging) and DAA therapy.

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.

active retrieval combining mailed invitations and telephone outreach effectively re-linked lost HCV patients to health care, enabling DAA treatment and supporting national elimination goals.