ReLink programs led to treatment, engagement in nearly 20% of patients with untreated HCV
WASHINGTON — Implementation of care re-engagement programs led to the treatment of more than 700 patients with untreated hepatitis C virus infection who had been lost to follow-up, according to research presented at The Liver Meeting.
“All in all, the ReLink programs have been able to relink 3,840 patients into care — that is, 31% of eligible patients being relinked and more than 700 patients were treated with direct-acting antivirals,” Maria Buti, MD, FAASLD, of Vall d’Hebron University Hospital in Barcelona, Spain, said during her presentation.
Buti and colleagues evaluated six ReLink programs from six different regions: the Netherlands, the United States, France, Latin America, Brazil and Spain. All programs utilized a health care record search except the U.S., which used a computer algorithm. Of 50,649 records, researchers reported 12,536 patients (25%) were lost to follow-up but were eligible to reconnect. Patients were most frequently lost to follow-up after diagnosis but before treatment, Buti said.
According to currently analyzed data, 3,840 patients (31%) were relinked while 7,197 patients were unreachable. The main reasons patients eligible for contact were not relinked included being unreachable (35%), already in care (11%) and deceased or transplanted (9%). Of those relinked, 714 (19%) received treatment with DAAs.
Each region employed their own care cascade with differing contact methods and rates of success. A letter or call to a general practitioner in France yielded a 49.7% rate of response, whereas a letter to a patient yielded a 50.3% response rate in France but a 7% response rate in Brazil and a 0.2% response rate in the U.S.
In addition, contact via text or WhatsApp produced a 13% response rate in Brazil, while a phone call yielded an 18% response rate in Brazil but a 51.6% response rate in the U.S.
According to researchers, use of a computer algorithm effectively identified patients, allowing more resources to be used for navigation and coordination, while a simplified care model yielded the highest relinked-to-treatment ratio.
“The major challenge of these programs is the ability to maintain contact information,” Buti said. “Regarding the way of contacting patients, all three were effective. We cannot say one is better than the other depending on the geography and their health system involved.”
She added, “Further validation of these pilot programs is needed in the post-COVID era.”
“It’s clearly cost-effective because ... if you can rescue these patients and you can treat, you avoid decompensation and liver transplantation,” she said. “In Spain, we have a universal [health care] system and ... it's really not only cost effective but cost saving.”