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 Before Initiating Treatment (CHCoC Step 5)

Even in the era of highly effective DAAs, treatment initiation rates are low. LTFU proves to be a large contributor to this problem. Retrospective studies have shown that only 12%-77% (median 29%) of patients diagnosed or engaged in care during the DAA era initiated treatment after being diagnosed with chronic HCV.Suppl file 1–5,13,34 Interventional studies aimed to improve the care cascade show that this rate can increase to 16%-100% (median 73%).Suppl file 18–28,33,35–39,50–53,59–62 Studies in the HIV field show similar results, with 36%-91% (median 90%) initiating treatment in retrospective studiesSuppl file 9–11 and 25%-100% (median 80%) in interventional studies.Suppl file 47–49 However, the treatment rate remains suboptimal in PWID with only 20%-90% (median 53%) initiating treatment.Suppl file 29–32,40,41 Generally, treatment initiation rates are higher in decentralized settings, both in PWID and non-PWID populations. Reasons for poor treatment initiation rates vary. Unfortunately, many countries still experience restrictions in who can and cannot be treated with DAAs.[14,15] This problem may especially apply to studies from the first stages of the DAA era.[16] Other reasons for poor treatment initiation rates may be comorbidities or perceived lack of compliance. However, LTFU contributes to a large extent to these poor rates. Studies showed that LTFU is the reason for nontreatment in 0%-67% (median 33%) of cases.Suppl file 3,5,13,19,25–27,32,40,41,53,61,62