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

Ensuring Retainment in Care

Efforts should be made to retain LTFU and non-LTFU patients in care. The cascade of care should be simplified as much as possible, as is stated in the call to action from the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver (APASL) and the Latin American Association for the Study of the Liver (ALEH), in partnership with the Clinton Health Access Initiative (CHAI).[28] Pre-treatment diagnostic assessment should be performed in one appointment. Treatment should be offered to all RNA-positive patients. Patients should be treated using pangenotypic regimens, making genotyping beforehand obsolete. Monitoring during treatment should be kept to a minimum. Care should be decentralized and/or integrated within other disease programmes as much as possible. Task-sharing between HCV specialists and other healthcare workers should be encouraged. Patients should be educated about the risk of re-infection. Lastly, some patients should be retained in post-SVR care, according to guidelines. This includes patients with a continuing risk of developing HCC, such as patients with advanced fibrosis (METAVIR score F3) or cirrhosis (F4) or patients with other risk factors such as excessive alcohol drinking, obesity and/or type 2 diabetes, but also patients with persisting abnormal liver tests that could indicate other causes of liver disease. These efforts can contribute to retainment in care and can therefore contribute to HCV elimination.