A systematic PCR record-based re-call of HCV-RNA-positive people enables re-linkage to care and HCV elimination in Austria - The ELIMINATE project

Lorenz Balcar, Michael Schwarz, Livia Dorn, Mathias Jachs, Lukas Hartl, Lukas Weseslindtner, Nikolaus Pfisterer, Barbara Hennlich, Annika Stückler, Robert Strassl, Astrid Voill-Glaninger, Wolfgang Hübl, Martin Willheim, Karin Köhrer, Sonja Jansen-Skoupy, Sabine Tomez, Walter Krugluger, Christian Madl, Lukas Burghart, Lukas AntonitschGerhard Weidinger, Florian Riedl, Hermann Laferl, Julian Hind, Christoph Wenisch, Christian Sebesta, Julia Wachter-Welzl, Paul Watzl, Magdalena Neuhauser, David Chromy, Mattias Mandorfer, Daniela Schmid, Michael Gschwantler, Thomas Reiberger, Andreas Maieron, David J M Bauer, Caroline Schwarz

Research output: Journal article (peer-reviewed)Journal article

Abstract

BACKGROUND AND AIMS: Identification of people living with hepatitis C virus (HCV) via readily available laboratory records could be a key strategy for macro-elimination, aligning with the WHO elimination goal. Therefore, the ELIMINATE(ELIMINation of HCV in AusTria East) project aimed to systematically re-link people with a 'last-positive' HCV-RNA PCR record to care.

METHODS: In 10 major liver centres in Eastern Austria, a systematic readout of 'last-positive' HCV-RNA PCR test records obtained between 2008 and 2020 were conducted and linked to available patient contact data. Between 2020 and 2023, individuals were contacted first by phone, then by letter, to inform them about the availability of effective direct-acting antiviral (DAA) treatment and invite them for pre-treatment evaluation.

RESULTS: The overall cohort of last-positive HCV+ individuals included 5695 subjects (62.5% males, mean age 57.3 ± 17.3 years); of note, 1931 (34%) of them had died and 759 (13%) individuals had no valid contact information. Of the remaining 3005 individuals, 1171 (40.0%) had already achieved sustained virological response (SVR) at the time of re-call. We successfully reached 617 (20.5%), of whom 417 (67.6%) attended their pre-treatment visit, and 397 (64.3%) commenced DAA-therapy. HCV cure has been confirmed in 326 individuals, corresponding to an SVR rate of 82.1%.

CONCLUSION: The ELIMINATE project identified 5695 people living with HCV who were 'lost to care' despite documented HCV viraemia. While invalid contact data were an evident barrier to HCV elimination, premature deaths among the cohort underscored the severity of untreated HCV. The implementation of a systematic HCV-RNA PCR recorded-based re-call workflow represents an effective strategy supporting the WHO goal of HCV elimination.

Original languageEnglish
Pages (from-to)3151-3163
Number of pages13
JournalLiver International
Volume44
Issue number12
Early online date01 Oct 2024
DOIs
Publication statusPublished - Dec 2024

Keywords

  • Disease Eradication/methods
  • Hepacivirus/genetics
  • Humans
  • Middle Aged
  • Male
  • Hepatitis C/drug therapy
  • Polymerase Chain Reaction/methods
  • RNA, Viral
  • Antiviral Agents/therapeutic use
  • Austria/epidemiology
  • Female
  • Adult
  • Hepatitis C, Chronic/drug therapy
  • Aged
  • Sustained Virologic Response

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