[[Re-Engagement of Hepatitis C Patients Lost to Follow-Up: A Multicenter Study from Argentina]].

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.