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A Retrospective Study on Hepatitis C Virus Infected Individuals Lost to Follow-Up in Ticino: The Hub and Spoke Approach

Background: Approximately 71.1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23.7 cases per 100,000 population in 2015, with an estimated 1.75 million new HCV infections diagnosed in 2015. In Switzerland, it is estimated that 37,000 patients have chronic HCV infection. In the Southern part of Switzerland liver disease patients are mainly followed at the six outpatient clinics of Epatocentro Ticino (EPT) connected with its hub in Lugano. The aim of the study was to identify lost to follow-up patients and reconnect them to specialist care. Methods: We used the database from EPT to identify HCV positive patients, who were lost to follow-up in the years 2007-2017. We consider lost to fol-low-up patients who had their last visit more than 2 years before closing date of analysis. We contacted the patients on the phone or by mail. Results: Overall 1271 patients have been at EPT between 2007 and 2017; of those 74 were lost to follow-up at the time of our screening. We received an answer from 60 of them. The results we collected were that 12 (6%) have died, 31 (42%) were currently followed by the General Practitioner (GP) or a different specialist, 9 (12%) were cured from HCV infection and did not need any further visit, and 4 (5%) refused to come for a check-up visit. In total, we rescued 4 (5%) patients and follow them at the EPT. Conclusion: Our look-back study revealed that our “Hub and Spoke-approach” had a high retention rate such that only 6% of our HCV patients were lost to follow-up. The look-back effort was still useful: the number of patients to recall identifying one patient needing treatment was 19.