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

Dijk, Marleen van; Drenth, Joost P.H.; Arends, Joop E.; Brakenhoff, Sylvia M.; Isfordink, Cas J; Knegt, RJ de; Valk, Marc van der

doi:10.1111/jvh.13399

Cited by 35 publications

(25 citation statements)

References 21 publications

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“…Yet, there was a subsequent drop in the cascade of care with treatment being completed in 90% of those who initiated. This finding is not surprising and consistent with the broader HCV literature among PWID where rates of loss to follow‐up or DAA treatment discontinuation have been reported in 5%–10% 11,16,47 . Treatment uptake was also higher than reported from mobile HCV clinics in Brisbane, Copenhagen and Madrid 32,35,37 .…”

Section: Discussionsupporting

confidence: 87%

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

Midgard

Bjørnestad²,

Egeland³

et al. 2022

Liver International

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Background & Aims: New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic.Methods: This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support.Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment.Results: Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years. Conclusions:A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres.

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Section: Discussionsupporting

confidence: 87%

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

Midgard

Bjørnestad²,

Egeland³

et al. 2022

Liver International

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“…LTFU at different stages of hepatitis C care is a major barrier in controlling HCV infection globally. [17] Timely treatment of hepatitis C reduces the risk of cirrhosis, hepatocellular carcinoma, and death [36, 37]. Therefore, LTFU from hepatitis C care can increase the risk of adverse health outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The cascade starts with hepatitis C antibody testing and ends with the determination of cure based on sustained virologic response (SVR) at 12 weeks after treatment completion [7][8][9][10][11][12][13][14][15][16]. Available data has found that loss to follow-up (LTFU) at different stages of the hepatitis C care cascade is common [17]. In 2019, globally, only 26% of people living with hepatitis C knew their infection status, and only 16% were treated [2].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C care cascade among patients with and without tuberculosis: findings from nationwide programs in the country of Georgia, 2015-2020

Baliashvili

Blumberg

Gandhi

et al. 2022

Preprint

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Background The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to evaluate loss to follow-up (LTFU) from the hepatitis C care cascade among persons diagnosed with active tuberculosis (TB) disease. Methods Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015, to September 30, 2020. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Results Among 11,985 patients with active TB, 9,065 (76%) were tested for HCV antibodies, and 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 20% of patients with a positive antibody test not undergoing viremia testing, and 43% of patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last three years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. Conclusions LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes. Existing large-scale programs for both TB and hepatitis C in Georgia create a unique opportunity for such integration to contribute to hepatitis C elimination efforts.

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“…However, strategies that use automatic reflex viral load testing of specimens found positive for HCV antibodies may be associated with reduced losses at these testing steps [ 42 ]. Other countries have productively addressed HCV care continuum gaps and have tested and implemented more efficient approaches [ 47 , 48 ]. Similarly, recently studied and implemented interventions for HIV have focused on condensing the steps in the HIV continuum of care and include rapid, same-day initiation of ART [ 49–53 ], and bundled HIV/HCV testing [ 54–56 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study’s high retention rates speak positively to participants’ adherence to study visits and thus suggest the need to further address structural and systemic issues that are complex and difficult to overcome even with a CF. These factors would include long waiting times, medication costs, social service needs (eg, unstable housing), and policies requiring sobriety that may serve as formidable barriers to forward movement along the HCV and HIV care continua [ 14 , 15 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064)

Metsch

Feaster

Gooden

et al. 2021

Open Forum Infectious Diseases

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Background Direct-acting antivirals can cure HCV. Persons with HCV/HIV and living with substance use are disadvantaged in benefitting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments completed in January 2018. Care facilitation group participants received motivation and strengths-based case-management addressing retrieval of HCV load results, engagement in HCV/HIV care and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (e.g., receiving HCV results, initiating treatment, sustained viral response) of the HCV/HIV care continuum over 12 months post-randomization. Results Three hundred and eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% male and 72.6% Black/African American. Median HIV-1 viral load was 27,209 copies/ml with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention (2.44 steps) vs. control group (1.68 steps) [χ 2(1)=7.36, p=0.0067]. Men in the intervention (vs. control) group completed a statistically significantly higher number of steps. Eleven participants achieved sustained viral response with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight the continued challenges to achieve individual patient sustained viral responses and population level HCV elimination.

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

Abstract: | on behalf of the HepNed study group This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 35 publications

References 21 publications

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

Hepatitis C care cascade among patients with and without tuberculosis: findings from nationwide programs in the country of Georgia, 2015-2020

Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064)

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