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

LTFU During Diagnostic Assessment (Chcoc Step 2)

The first step in diagnosing chronic HCV is the determination of presence of HCV antibodies. However, the key step in confirming the diagnosis of chronic HCV is determining HCV RNA (or HCV core antigen when RNA assays are not available or not affordable).[13] In many countries, HCV RNA is not tested automatically after receiving a positive antibody test result. This two-step diagnosis provides the first opportunity for patients to become LTFU. Two retrospective, observational studies have shown that approximately 72% of their anti-HCV-positive populations were tested for HCV RNA.Suppl file 1,2 This percentage is generally higher in interventional studies aiming to improve the cascade of care, often done in community-based settings: 67%-100% (median 90%).Suppl file 20–23,50–52,59 However, some studies have shown that only 7%Suppl file 18 or 18%Suppl file 24 of anti-HCV-positive people receive confirmatory testing. Reasons for this vary and are often unreported, but might be due to LTFU. One study confirmed that 32% of anti-HCV-positive people were LTFU before receiving an RNA test.Suppl file 50 Reflex testing, where the laboratory automatically tests for HCV RNA or HCV core antigen when the antibody test proves to be positive, improves this step in the cascade of care.Suppl file 27