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Identifying and Linking to Care and Treatment Persons With Hepatitis C Who Were Lost to Follow-Up, Georgia 2023-2024
Vladimer Getia1, Paata Imnadze1, Eka Adamia1
1National Center for Disease Control and Public Health, Tbilisi, Georgia.
Insights
Georgia
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Georgia's hepatitis C elimination program launched in 2015.
- Significant patient loss to follow-up occurred after screening and diagnosis.
- Barriers to care and treatment engagement needed assessment.
Purpose of the Study:
- To re-engage patients lost to follow-up in hepatitis C care.
- To identify barriers preventing access to hepatitis C treatment.
- To evaluate the effectiveness of active outreach strategies.
Main Methods:
- Active outreach conducted from February 2023 to September 2024.
- Questionnaires assessed pre- and post-outreach perceptions and barriers.
- Analysis of patient engagement in viremia testing and treatment initiation.
Main Results:
- 79% of eligible lost-to-follow-up patients were reached; 64% were unaware of their HCV antibody status.
- 32% completed viremia testing, with 53% testing positive; 65% initiated treatment post-outreach.
- Key barriers included other chronic illnesses and lack of awareness; distrust emerged post-outreach.
Conclusions:
- Active outreach successfully re-engaged patients and identified new hepatitis C infections.
- Patient education on test results and timely linkage to care are crucial for elimination.
- Addressing patient-reported barriers is essential for program success.
Abstract:
In 2015, Georgia launched a hepatitis C elimination programme with free screening and treatment. However, a large number of persons were lost to follow up after screening for, or diagnosis with, hepatitis C virus (HCV) infection. During February 2023-September 2024, we conducted active outreach to reengage persons who were lost to follow-up in care and assess barriers to hepatitis C care and treatment through questionnaires covering pre- and post-outreach perceptions. Among 18,034 persons who tested HCV antibody (anti-HCV) reactive but were not tested for HCV viremia and had valid contact information, 14,252 (79%) could be reached, among whom 64% were unaware of their test result. After outreach, 4593 (32%) completed HCV viremia testing, among whom 2440 (53%) tested positive and 1577 (65%) initiated treatment. Main reasons for not seeking care after active outreach were having another chronic illness (33%) and being unaware they were screened for anti-HCV (23%). Among 13,151 persons diagnosed with HCV infection who did not initiate treatment and had valid contact information, 6982 (53%) were reached, among whom 2267 (33%) initiated treatment. The main reason for not initiating treatment before outreach was lack of information (62%) and after outreach was distrust in the hepatitis C elimination programme (79%). Treatment initiation was more common among those first tested in recent years. Active outreach successfully identified new infections and nearly 40% of those diagnosed initiated treatment. Educating patients about their test results and promptly linking them to care and treatment is essential to achieve hepatitis C elimination.
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