REtrieval And cure of Chronic Hepatitis C (REACH): Results of micro‐elimination in the Utrecht province

• Published in: Liver international Vol. 39; no. 3; pp. 455 - 462
• Main Authors: Kracht, Patricia A. M., Arends, Joop E., van Erpecum, Karel J., Thijsen, Steven F. T., Vlaminckx, Bart J. M., Weersink, Annemarie J. L., Wensing, Anne M. J., Deege, Marjolein P. H., Dimmendaal, Marieke, Stadhouders, Paul H. G. M., Friederich, Philip W., Verhagen, Marc A. M. T., Boland, Greet J., Hoepelman, Andy I. M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2019
• Subjects: Antiviral agents; Antiviral Agents - therapeutic use; case‐finding; Chronic infection; Complications; Diagnostic systems; direct‐acting antivirals; Disease Eradication; Feasibility Studies; Female; Health care; Hepatitis; Hepatitis C; hepatitis C virus; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Hepatitis C, Chronic - prevention & control; Humans; Immunoglobulin G; Interferon; Intravenous administration; Laboratories; Lost to Follow-Up; Male; Mass Screening - methods; micro‐elimination; Middle Aged; Netherlands - epidemiology; Patients; Predictive Value of Tests; Program Evaluation; REACH; Retrieval; Ribonucleic acid; RNA; RNA viruses; Screening; Therapy; Time Factors; Treatment Outcome; Viruses; Netherlands; REACH; hepatitis C virus; micro-elimination; retrieval; case-finding; direct-acting antivirals
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13959

Background The Netherlands is one of the six European countries considered on track to eliminate hepatitis C virus by 2030. To achieve this goal, continuous efforts have to be put into designing efficient case‐finding strategies, including the retrieval of previously diagnosed hepatitis C virus‐infected who are lost to follow‐up. Aims To trace and treat all lost to follow‐up hepatitis C virus patients in the Utrecht region and create an efficient retrieval strategy that can be used in future (national) retrieval initiatives. Methods Positive hepatitis C virus diagnostic tests (anti‐hepatitis C virus IgG or hepatitis C virus‐RNA) from the laboratory of all four hospitals and one central laboratory for primary care diagnostics in the province of Utrecht from 2001 to 2015 were linked to clinical records. Untreated patients with available contact information were deemed eligible for retrieval and invited for reevaluation with (virology) blood tests, fibroscan measurement and possible direct‐acting antiviral therapy. Main results After screening all hepatitis C virus diagnostics, 1913 chronic hepatitis C virus‐infected were identified of which 14.1% (n = 269) were invited back into care. Overall, 17.4% was traced with the highest yield (28.3%) in those who lived in the Utrecht province. Through renewed patient assessments, 42 chronic hepatitis C virus infections were re‐identified (76% with a history of intravenous drug use, 24% with Metavir F3‐F4). Until now, 59% has either scheduled or initiated direct‐acting antiviral therapy. Conclusion The retrieval of previously diagnosed hepatitis C virus patients through screening of laboratory diagnostics from the past is feasible and should be pursued for further control and reduction of hepatitis C virus infection. Retrieval is most successful when performed regionally. Lay summary To completely eliminate chronic hepatitis C virus (HCV) infection and prevent complications, undiagnosed and also previously diagnosed but lost to follow‐up (LFU) HCV patients have to be brought (back) into care for therapy. Retrieval of LFU HCV patients through screening of laboratory diagnostics from the past is feasible and most successful when performed regionally.