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. 2024 Jan;44(1):52-60.
doi: 10.1111/liv.15729. Epub 2023 Sep 17.

Socio-economic factors associated with loss to follow-up among individuals with HCV: A Dutch nationwide cross-sectional study

Marleen van Dijk  1 , Anders Boyd  2   3   4 , Sylvia M Brakenhoff  5 , Cas J Isfordink  2   6 , Rosan A van Zoest  7 , Mark D Verhagen  8 , Robert J de Knegt  5 , Joost P H Drenth  1 , Marc van der Valk  2   3 ; HepNed study group
Collaborators, Affiliations

Socio-economic factors associated with loss to follow-up among individuals with HCV: A Dutch nationwide cross-sectional study

Marleen van Dijk et al. Liver Int. 2024 Jan.

Abstract

Background and aims: The path to hepatitis C virus (HCV) elimination is complicated by individuals who become lost to follow-up (LTFU) during care, particularly before receiving effective HCV treatment. We aimed to determine factors contributing to LTFU and whether LTFU is associated with mortality.

Methods: In this secondary analysis, we constructed a database including individuals with HCV who were either LTFU (data from the nationwide HCV retrieval project, CELINE) or treated with directly acting antivirals (DAA) (data from Statistics Netherlands) between 2012 and 2019. This database was linked to mortality data from Statistics Netherlands. Determinants associated with being LTFU versus DAA-treated were assessed using logistic regression, and mortality rates were compared between groups using exponential survival models. These analyses were additionally stratified on calendar periods: 2012-2014, 2015-2017 and 2018-2019.

Results: About 254 individuals, LTFU and 5547 DAA-treated were included. Being institutionalized (OR = 5.02, 95% confidence interval (CI) = 3.29-7.65), household income below the social minimum (OR = 1.96, 95% CI = 1.25-3.06), receiving benefits (OR = 1.74, 95% CI = 1.20-2.52) and psychiatric comorbidity (OR = 1.51, 95% CI = 1.09-2.10) were associated with LTFU. Mortality rates were significantly higher in individuals LTFU compared to those DAA-treated (2.99 vs. 1.15/100 person-years (PY), p < .0001), while in those DAA-treated, mortality rates slowly increased between 2012-2014 (.22/100PY) and 2018-2019 (2.25/100PY).

Conclusion: In the Netherlands, individuals who are incarcerated/institutionalized, with low household income, or with psychiatric comorbidities are prone to being LTFU, which is associated with higher mortality. HCV care needs to be adapted for these vulnerable individuals.

Keywords: hepatitis C; lost to follow-up; mortality; socio-economic status.

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References

REFERENCES

    1. World Health Organization. Global Health Sector Strategy on Viral Hepatitis, 2016-2021. World Health Organization; 2016 Contract No.: WHO/HIV/2016.06.
    1. van Dijk M, Drenth JPH. Loss to follow-up in the hepatitis C care cascade: a substantial problem but opportunity for micro-elimination. J Viral Hepat. 2020;27(12):1270-1283.
    1. Isfordink CJ, van Dijk M, Brakenhoff SM, et al. Hepatitis C elimination in the Netherlands (CELINE): how nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination. Eur J Intern Med. 2022;101:93-97.
    1. Isfordink CJ, Brakenhoff SM, van Dijk M, et al. Hepatitis C elimination in the Netherlands (CELINE): study protocol for nationwide retrieval of lost to follow-up patients with chronic hepatitis C. BMJ Open Gastroenterol. 2020;7(1):e000396.
    1. Falade-Nwulia O, Sutcliffe CG, Mehta SH, et al. Hepatitis C elimination in people with HIV is contingent on closing gaps in the HIV continuum. Open Forum Infect Dis. 2019;6(10):ofz426.

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