Loss to Follow-up in the Hepatitis C Care Cascade: A Substantial Problem but Opportunity for Micro-elimination

Micro-elimination of LTFU Patients Through Retrieval

LTFU occurs in all steps of the care cascade and may severely impact HCV care and opportunities for cure. It is reasonable to assume that data from the interferon era on LTFU are worse, due to the fact that fewer patients had an indication for treatment, more patients refused treatment, fewer patients finished the ill-tolerated treatment and only a limited number of patients achieved cure, compared to the DAA era. This hypothesis was confirmed in a recent study by Aleman et al^[19] The authors included HCV patients from their national register diagnosed between 2001 and 2011 and alive in 2013, and found that an impressive 61% was LTFU. A study from Belgium using a similar approach showed that PWID and patients who never received HCV treatment had a higher risk of becoming LTFU (OR 2.2 for both).^[20] This provides us with an opportunity as the LTFU HCV population may be an excellent candidate for micro-elimination, the process of eliminating HCV in subpopulations.^[21] Micro-elimination is the favoured approach in many countries, especially in those with a relatively low national prevalence, but higher prevalence in specific subpopulations. Lazarus et al have recently described which subpopulations should be considered for micro-elimination, such as aboriginal and indigenous communities, HIV/HCV-coinfected people, migrants from high-prevalence countries, people who inject drugs, people with inherited blood disorders and prisoners.^[22] We propose that LTFU patients should be added to this list. As indicated, LTFU is a substantial problem across the entire care cascade. Because this HCV population has already been identified, it is obvious that retrieval of these patients can be considered 'low-hanging fruit'.

J Viral Hepat. 2020;27(12):1270-1283. © 2020 Blackwell Publishing