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

A Substantial Problem But Opportunity for Micro-elimination

Marleen van Dijk; Joost P.H. Drenth


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

In This Article

Retrieval in the Netherlands: The Celine Project

Several regional projects have been executed in the Netherlands focused on the LTFU population. We found that up to 14% of our HCV population diagnosed in the previous 15 years was LTFU before being cured and eligible for retrieval.[23–25] Based on best practices from these projects, a nationwide approach was developed.[26,27] The hepatitis C Elimination in the Netherlands (CELINE) project aims to retrieve LTFU chronic HCV patients and re-engage them with care. The protocol is described in detail elsewhere.[27] In short, we identify diagnosed patients based on laboratory data, which we combine with information from their medical records. Patients who were still HCV-positive when they left care are classified as eligible for retrieval if they are alive and currently residing in the Netherlands. They are subsequently invited by letter to an outpatient clinic of their choice after their current address is verified through municipality records or general practitioners. Data will be collected on patient and disease characteristics of patients who sign informed consent.

What we have learned since the start of CELINE in 2018 is that retrieval is feasible when conducted by a dedicated team. The project gives great insight into our care cascade and gives vital information for our hepatitis elimination plan. The nationwide approach ensures that retrieval is done to the same standards in each participating centre. Identification of LTFU patients and ensuring they adhere to their clinic appointments are the most time-consuming. This is why we advise that a dedicated team, rather than individual clinicians, should execute these tasks.