Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands; Division of Infectious Diseases, Amsterdam Infection & Immunity Institute Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Eur J Intern Med. 2022 Jul;101:93-97. doi: 10.1016/j.ejim.2022.04.024. Epub 2022 May 5.
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.
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.
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.
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.
慢性丙型肝炎病毒（HCV）感染者失访（LTFU）的人数居高不下，这对 HCV 消除工作构成了威胁。针对荷兰等低流行国家，以 LTFU 人群为重点的微消除策略具有很大的潜力（HCV 流行率为 0.16%）。因此，我们在荷兰启动了一项针对 LTFU HCV 患者的全国性检索项目。
利用实验室和患者记录确定 LTFU HCV 感染者。随后，查询市级个人记录数据库以确定符合检索条件的个体，这些个体定义为在荷兰仍然存活且具有已知地址。这些个体被邀请重新评估。主要终点是成功重新联系到护理的患者数量。
在荷兰的 45 个地点实施了检索。在 20183 名曾被诊断的患者中，13198 名（65%）已治愈或仍在接受治疗，1537 名（8%）为 LTFU 且符合检索条件。邀请的 1537 名个体中，有 888 名（58%）建立了联系；369 名（24%）曾在其他地方接受过成功治疗，131 名（9%）拒绝重新评估，251 名（16%）被转介进行重新评估。最终，219 名（14%）进行了重新评估，其中 172 名（79%）同意进一步收集数据。在 172 名同意进一步收集数据的患者中，143 名（83%）HCV-RNA 阳性，其中 38 名（27%）有晚期纤维化或肝硬化，123 名（86%）开始接受抗病毒治疗。
我们的全国性微消除策略准确地描绘了荷兰曾被诊断的 HCV 人群，表明重新联系到护理的 27%的 LTFU HCV 感染者有晚期纤维化或肝硬化。这强调了系统检索对 HCV 消除的潜在价值。
