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Review
. 2020 Dec;27(12):1270-1283.
doi: 10.1111/jvh.13399. Epub 2020 Sep 22.

Loss to follow-up in the hepatitis C care cascade: A substantial problem but opportunity for micro-elimination

Marleen van Dijk  1 , Joost P H Drenth  1 ; HepNed study group
Collaborators, Affiliations
Review

Loss to follow-up in the hepatitis C care cascade: A substantial problem but opportunity for micro-elimination

Marleen van Dijk et al. J Viral Hepat. 2020 Dec.

Abstract

Since the advent of direct-acting antivirals, elimination of hepatitis C viral (HCV) infections seems within reach. However, studies on the HCV cascade of care show suboptimal progression through each step for all patient groups. Loss to follow-up (LTFU) is a major issue and is a barrier to HCV elimination. This review summarizes the scale of the LTFU problem and proposes a micro-elimination approach. Retrieving LTFU patients and re-engaging them with care again has shown to be feasible in the Netherlands. Micro-elimination through retrieval can contribute to reaching the World Health Organization's viral hepatitis elimination targets by 2030.

Keywords: cascade of care; hepatitis C; lost to follow-up; micro-elimination.

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Figures

FIGURE 1
FIGURE 1
Hepatitis C care cascade. Step 1: HCV prevalence; step 2: diagnosed with chronic HCV; step 3: linked to care; step 4: liver disease assessed; step 5: started on treatment; step 6: achieved SVR; step 7: accessed chronic post‐SVR care. Figure freely adapted with permission from Safreed‐Harmon et al. 12 HCV, hepatitis C virus; LTFU, lost to follow‐up; SVR, sustained virological response
FIGURE 2
FIGURE 2
Intention‐to‐treat sustained virological response percentages in studies included in this review in mixed populations, people who inject(ed) drugs and HIV/HCV‐coinfected patients. Each line represents one study or one study group. The corresponding number refers to the reference in Supporting File 1
See this image and copyright information in PMC

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