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Abstract Details
Hepatitis C Elimination in the Netherlands (CELINE): How nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination
1Department 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.
2Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
3Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
4Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands.
5Division of Infectious Diseases, Amsterdam Infection & Immunity Institute Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
6Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: Joost.Drenth@radboudumc.nl.
7Dpt. of Infectious Diseases, Admiraal de Ruiter Hospital, Goes.
8Dpt. of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht.
9Dpt. of Gastroenterology and Hepatology, Alrijne Hospital, Leiderdorp.
10Dpt. of Infectious Diseases, Amphia, Breda.
11Dpt. of Gastroenterology and Hepatology, Bernhoven, Uden.
12Dpt. of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven.
13Dpt. of Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen.
14Dpt. of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen.
15Dpt. of Gastroenterology and Hepatology, Deventer Hospital, Deventer.
16Dpt. of Medical Microbiology, Deventer Hospital, Deventer.
17Dpt. of Gastroenterology and Hepatology, Diakonessen Hospital, Utrecht.
18Dpt. of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn.
19Dpt. of Infectious Diseases, Flevo Hospital, Almere.
20Dpt. of Gastroenterology and Hepatology, Gelre, Apeldoorn.
21Dpt. of Medical Microbiology, Gelre, Apeldoorn.
22Dpt. of Social Medicine and Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht.
23Dpt. of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda.
24Dpt. of Gastroenterology and Hepatology, Haaglanden MC, the Hague.
25Dpt. of Gastroenterology and Hepatology, IJsselland, Capelle aan den IJssel.
26Dpt. of Gastroenterology and Hepatology, Ikazia, Rotterdam.
27Dpt. of Internal Medicine / Infectious Diseases, Isala, Zwolle.
28Dpt. of Medical Microbiology, Isala, Zwolle.
29Dpt. of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's- Hertogenbosch.
30Dpt. of Gastroenterology and Hepatology, Laurentius Hospital, Roermond.
31Dpt. of Medical Microbiology, Laurentius Hospital, Roermond.
32Dpt. of Infectious Diseases, Maasstad, Rotterdam.
33Dpt. of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort.
34Dpt. of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden.
35Dpt. of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede.
36Laboratory for Medical Microbiology and Public Health, Hengelo.
37Dpt. of Medical Microbiology, Maastricht University Medical Centre, Maastricht.
38Dpt. of Integrated Care, Maastricht University Medical Centre (MUMC+), Maastricht.
39Dpt. of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
40Dpt. of Gastroenterology and Hepatology, Noordwest Hospital, Alkmaar.
41Dpt. of Gastroenterology & Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam.
42Dpt. of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft.
43Dpt. of Gastroenterology and Hepatology, Rijnstate, Arnhem.
44Dpt. of Clinical Microbiology and Immunology, Rijnstate, Arnhem.
45Dpt. of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen.
46Dpt. of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen.
47Dpt. of Gastroenterology and Hepatology, VieCuri, Venlo.
48Dpt. of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede.
49Dpt. of Gastroenterology and Hepatology, Zuyderland, Sittard/Heerlen.
Abstract
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.