Innovative linkage model to re-engage loss-to-follow-up individuals in the national hepatitis C elimination program of Georgia

ABSTRACT

Background and aims: The National Hepatitis C Elimination Program has made notable progress in Georgia. However, in the setting of COVID-19 related limitations, the number of individuals registering in the treatment program has declined over time, from an average of 996 per month in 2019 to 339 per month in 2021. As of September 30, 2021, 75% (n = 2, 081, 548) of the adult population of Georgia has been screened for hepatitis C virus (HCV), but among antibody positive adults, 20, 913 (15%) had not completed a viremia test. In 2019, the National Center for Disease Control and Public Health Georgia piloted a project to link to care those individuals who screened positive for anti-HCV but had not completed a viremia test. After success of the initial pilot, the model will be scaled up across Georgia. Method: All anti-HCV positive adults (aged ≥18 years) who did not have record of viremia testing in the national HCV electronic database 3 months from the date of a positive result, and who were not registered in the HIV/AIDS program or with a correctional facility, were eligible for follow-up. Using the phone number listed in the database, individuals were contacted by phone or home visit by patient navigators (trained epidemiologists and primary healthcare physicians) and referred to HCV care and treatment. If the first attempt was unsuccessful, one repeat attempt was made to contact the individual. Incentives were provided to regional health personnel for each patient that was successfully linked to care, defined as presenting for viremia testing. Results: As of October 1, 2020, 18, 030 persons were not linked to care;patient navigators attempted to reach 8, 907 (49%) with phone numbers in the database;6, 718 (75%)were reached. The remaining 2, 189 could not be reached, had moved, or emigrated. Of those contacted, 1, 546 (23%) presented for viremia testing, and 811 (52%) were positive for HCV RNA or core antigen. Overall, 419 (52%) persons with chronic HCV infection were enrolled in the HCV treatment program as a result of this effort. Conclusion: Program-wide implementation of the piloted model showed that this can be scaled up and is effective for re-engaging people in care. The main challenge in Georgia remains linkage-tocare, which is essential to meet elimination goals. Innovative approaches are necessary to reinforce linkage to care. This is especially important during the COVID-19 pandemic when there is an increased need for programs that can re-engage people in HCV care.