A systematic PCR record-based re-call of HCV-RNA-positive people enables re-linkage to care and HCV elimination in Austria - The ELIMINATE project

Abstract

Background and aims: Identification of people living with hepatitis C virus (HCV) via readily available laboratory records could be a key strategy for macro-elimination, aligning with the WHO elimination goal. Therefore, the ELIMINATE(ELIMINation of HCV in AusTria East) project aimed to systematically re-link people with a 'last-positive' HCV-RNA PCR record to care.

Methods: In 10 major liver centres in Eastern Austria, a systematic readout of 'last-positive' HCV-RNA PCR test records obtained between 2008 and 2020 were conducted and linked to available patient contact data. Between 2020 and 2023, individuals were contacted first by phone, then by letter, to inform them about the availability of effective direct-acting antiviral (DAA) treatment and invite them for pre-treatment evaluation.

Results: The overall cohort of last-positive HCV+ individuals included 5695 subjects (62.5% males, mean age 57.3 ± 17.3 years); of note, 1931 (34%) of them had died and 759 (13%) individuals had no valid contact information. Of the remaining 3005 individuals, 1171 (40.0%) had already achieved sustained virological response (SVR) at the time of re-call. We successfully reached 617 (20.5%), of whom 417 (67.6%) attended their pre-treatment visit, and 397 (64.3%) commenced DAA-therapy. HCV cure has been confirmed in 326 individuals, corresponding to an SVR rate of 82.1%.

Conclusion: The ELIMINATE project identified 5695 people living with HCV who were 'lost to care' despite documented HCV viraemia. While invalid contact data were an evident barrier to HCV elimination, premature deaths among the cohort underscored the severity of untreated HCV. The implementation of a systematic HCV-RNA PCR recorded-based re-call workflow represents an effective strategy supporting the WHO goal of HCV elimination.

Keywords: DAA; WHO; elimination; hepatitis C.

FIGURE 1

Overview of the macro‐elimination ELIMINATE program in Eastern Austria. Ten tertiary care centres in Eastern Austria collaborated on a macro‐elimination strategy targeting Hepatitis C. We re‐called individuals with a documented ‘last‐positive’ HCV RNA PCR from 2008 to 2020. Systematic outreach was conducted via telephone or mailed letter to re‐establish linkage to care. During the initial visit at the respective centres' outpatient clinic, we reassessed each patient's current HCV status and liver disease severity. Confirmed cases of HCV viraemia led to the immediate offer and, upon acceptance, start of direct acting antiviral (DAA) therapy. A follow‐up visit confirmed sustained virological response (SVR) through PCR re‐evaluation. DAA, direct acting antiviral agents; HCV, hepatitis C virus; Rx, prescription; SVR, sustained virological response.

FIGURE 2

Patient care cascade overview. In total, we identified more than 5695 ‘last‐positive’ PCRs records across participating hospital databases. Valid contact information was available for 3005 patients, of whom one third had already achieved SVR12 before. We successfully contacted 617 patients, 417 of whom attended their first visit at the respective outpatient clinics. DAA‐therapy was initiated in 397 patients, with 326 achieving confirmed SVR. Alarmingly, a third of the overall cohort was found deceased between the last HCV‐RNA PCR and re‐call through our project. DAA, direct acting antiviral agents; SVR, sustained virological response.

FIGURE 3

Comparative analysis of LSM pre‐ and post‐antiviral treatment. LSM by vibration‐controlled transient elastography in kPa among 95 patients with available LSM data. DAA, direct acting antiviral agents; LSM, liver stiffness measurement SVR, sustained virological response.

FIGURE 4

Comparison of Kaplan–Meier curves of individuals who achieved versus did not achieve sustained virological response (SVR).