Acta gastroenterologica Latinoamericana · 2026
[[Re-Engagement of Hepatitis C Patients Lost to Follow-Up: A Multicenter Study from Argentina]].
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Cairo Fernando, Domínguez Nicolás, Curia Andrea, Navarro Lucía, Barbero Manuel, Trillo Ayelen, Calfunao Daniel, Belloni Rodrigo, Bologna Anselmo Adrián, Burgos Estefanía, Susana Melina, Borzi Silvia Mabel, Galdame Omar Andrés, Ballerga Esteban González, Roca Ignacio
Аннотация
BACKGROUND AND AIMS.: Many anti-HCV-positive individuals in Argentina remain lost to follow-up. We assessed a multicenter re-engagement program using complementary case-finding strategies, described the care cascade, and evaluated treatment outcomes.
METHODS.: Five public hospitals implemented two strategies: laboratory-based screening at a tertiary hospital and its primary/secondary network, and combined medical-record/laboratory searches at four tertiary hospitals to identify prior anti-HCV positives. Lost to follow-up was operationally defined as no documented hepatology care, HCV RNA testing, or antiviral treatment within participating institutions for ≥ 12 months. A two-visit pathway was offered. Primary outcomes were re-engagement, treatment initiation, and SVR12; secondary outcomes were fibrosis stage and SVR4-SVR12 concordance. As an exploratory objective, all-cause mortality was assessed in the laboratory cohort using conditional logistic regression.
RESULTS.: Across 206,053 data sources (106,917 laboratory samples; 99,136 medical records), 3,334 individuals were anti-HCV positive. After excluding cured (n = 741), deceased (n = 419), and liver-transplanted (n = 25) patients, 2,149 were potentially eligible for re-engagement; 422 (19.6%) re-engaged. Three hundred eleven (73.7%) had significant fibrosis (≥ F2 by FibroScan®). Antiviral therapy began in 224 patients: sofosbuvir/velpatasvir 70.1% and glecaprevir/pibrentasvir 29.9%. SVR12 was 97.9%; in a subset (n = 112), SVR4 showed 100% concordance with SVR12. In the laboratory cohort, anti-HCV positivity was associated with higher all-cause mortality (OR 4.75; 95% CI 3.82 - 5.94).
CONCLUSIONS.: Complementary case-finding plus a two-visit pathway enabled effective re-engagement and timely treatment, achieving near-universal SVR. This scalable model supports HCV micro-elimination across public hospital networks.
METHODS.: Five public hospitals implemented two strategies: laboratory-based screening at a tertiary hospital and its primary/secondary network, and combined medical-record/laboratory searches at four tertiary hospitals to identify prior anti-HCV positives. Lost to follow-up was operationally defined as no documented hepatology care, HCV RNA testing, or antiviral treatment within participating institutions for ≥ 12 months. A two-visit pathway was offered. Primary outcomes were re-engagement, treatment initiation, and SVR12; secondary outcomes were fibrosis stage and SVR4-SVR12 concordance. As an exploratory objective, all-cause mortality was assessed in the laboratory cohort using conditional logistic regression.
RESULTS.: Across 206,053 data sources (106,917 laboratory samples; 99,136 medical records), 3,334 individuals were anti-HCV positive. After excluding cured (n = 741), deceased (n = 419), and liver-transplanted (n = 25) patients, 2,149 were potentially eligible for re-engagement; 422 (19.6%) re-engaged. Three hundred eleven (73.7%) had significant fibrosis (≥ F2 by FibroScan®). Antiviral therapy began in 224 patients: sofosbuvir/velpatasvir 70.1% and glecaprevir/pibrentasvir 29.9%. SVR12 was 97.9%; in a subset (n = 112), SVR4 showed 100% concordance with SVR12. In the laboratory cohort, anti-HCV positivity was associated with higher all-cause mortality (OR 4.75; 95% CI 3.82 - 5.94).
CONCLUSIONS.: Complementary case-finding plus a two-visit pathway enabled effective re-engagement and timely treatment, achieving near-universal SVR. This scalable model supports HCV micro-elimination across public hospital networks.