Callbacks Help Prevent Lost HCV Patients

A better method of follow-up could help prevent patients with hepatitis C virus (HCV) infections from developing more severe outcomes that lead to other diseases.

A team, led by Hsu-Heng Yen, Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, found more call-backs to HCV positive patients that were lost during the appropriate follow-up period led to additional patients ultimately seeking treatment for HCV.

HCV can cause several other diseases, including chronic liver disease, cirrhosis, and liver cancer.

Lost Patients

In the study, the investigators examined patients who had prior tests for positive anti-HCV antibodies between 2010-2018. The follow-up campaign took place between January 2020 and October 2020 with patients who had unknown HCV RNA status or no documented successful antiviral therapy history.

The research team evaluated the campaign for retrieving HCV patients who were lost during follow-up for subsequent re-evaluation in an effort to better treat the disease.

The investigators also developed an electronic reminding system and called the candidate patients on the telephone during the study period to facilitate patient referral.

Retained Patients

The research team identified 3783 patients with positive anti-HCV antibody documentation through the hospital electronic system., 38.22% (n = 1446) of which tested negative for HCV RNA or had anti-HCV therapy. These patients were excluded from the final analysis.

Of the remaining 2337 patients, 62.99% (n = 1472) were successfully contacted and called back during the study for subsequent HCV RNA testing and therapy.

Overall, 42.19% of the patients had positive HCV RNA, while 88% of the patients received subsequent anti-HCV therapy.

“A significant number of patients with positive HCV serology were lost for HCV confirmatory test or therapy in the hospital,” the authors wrote. “Therefore, this targeted HCV callback approach in the hospital is feasible and effective in achieving microelimination.”

Better Results with HCV Screenings

New research shows only screening for hepatitis C virus (HCV) by risk in pregnant women results in a large percentage of missed diagnoses.

Current recommendations from the US Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF) call for universal hepatitis c virus screening in pregnant women. In addition, the Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) recommend risk-based screening for HCV in pregnancy.

In the retrospective cohort study, the researchers examined pregnant women who were screening for hepatitis C at a single tertiary-care center. The patients were split into 2 cohorts—women managed with risk-based screenings between January 2014 and October 2016 and women universally screened between November 2016 and December 2018.

There was a 29% (n = 76) positivity rate for HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (n = 90) in the universal cohort.

However, only 69% (n = 62) of HCVAb+ women in the universal cohort met the criteria for risk-based testing and of the remaining 28 women, 21% (n=6) had active viremia (HCV RNA+).

The researchers also found 64% (n = 103) of the HCVAb+ women were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6773 (0.8%) in the universal cohort.

In addition, 75% (n = 125) of HCVAb+ women were referred postpartum for HCV evaluation and 27% (n = 34) were linked to care and only 9% (n =10) of women with viremia-initiated treatment within 1 year of delivery.

The study, “Retrieval of lost patients in the system for hepatitis C microelimination: a single-center retrospective study,” was published online in BMC Gastroenterology.