Background & Aims: The number of chronic hepatitis C virus (HCV)-infected patients who have been lost to follow-up (LTFU) is high and threatens HCV elimination. Micro-elimination focusing on the LTFU population is a promising strategy for low-endemic countries like the Netherlands (HCV prevalence 0.16%). We therefore initiated a nationwide retrieval project in the Netherlands targeting LTFU HCV patients. Methods: LTFU HCV-infected patients were identified using laboratory and patient records. Subsequently, the Municipal Personal Records database was queried to identify individuals eligible for retrieval, defined as being alive and with a known address in the Netherlands. These individuals were invited for re-evaluation. The primary endpoint was the number of patients successfully re-linked to care. Results: Retrieval was implemented in 45 sites in the Netherlands. Of 20,183 ever-diagnosed patients, 13,198 (65%) were known to be cured or still in care and 1,537 (8%) were LTFU and eligible for retrieval. Contact was established with 888/1,537 (58%) invited individuals; 369 (24%) had received prior successful treatment elsewhere, 131 (9%) refused re-evaluation and 251 (16%) were referred for re-evaluation. Finally, 219 (14%) were re-evaluated, of whom 172 (79%) approved additional data collection. HCV-RNA was positive in 143/172 (83%), of whom 38/143 (27%) had advanced fibrosis or cirrhosis and 123/143 (86%) commenced antiviral treatment. Conclusion: Our nationwide micro-elimination strategy accurately mapped the ever-diagnosed HCV population in the Netherlands and indicates that 27% of LTFU HCV-infected patients re-linked to care have advanced fibrosis or cirrhosis. This emphasizes the potential value of systematic retrieval for HCV elimination.
Bibliographical noteFunding Information:
CELINE was supported with an unrestricted grant from Gilead Sciences. The funder did not have any role in study design, data collection, management, analysis and/or interpretation. Wherever possible, CELINE included and expanded on data from regional retrieval projects. The REtrieval And cure of Chronic Hepatitis C (REACH) project was supported with unrestricted grants from Gilead Sciences, Merck Sharpe & Dohme (MSD), AbbVie and Bristol-Myers Squibb (BMS). The Zuyderland project was financially supported by grants from Gilead Sciences and MSD. The Track Trace & Treat project was financially supported by a grant from MSD. Projects from the Leiden University Medical Centre, Haga Teaching Hospital and Medical Centre Leeuwarden were financially unsupported.