Hepatitis C Elimination in the Netherlands (CELINE): How nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination

Cas J. Isfordink, Marleen van Dijk, Sylvia M. Brakenhoff, Patricia A.M. Kracht, Joop E. Arends, Robert J. de Knegt, Marc van der Valk, Joost P.H. Drenth

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Background & Aims: The number of chronic hepatitis C virus (HCV)-infected patients who have been lost to follow-up (LTFU) is high and threatens HCV elimination. Micro-elimination focusing on the LTFU population is a promising strategy for low-endemic countries like the Netherlands (HCV prevalence 0.16%). We therefore initiated a nationwide retrieval project in the Netherlands targeting LTFU HCV patients. Methods: LTFU HCV-infected patients were identified using laboratory and patient records. Subsequently, the Municipal Personal Records database was queried to identify individuals eligible for retrieval, defined as being alive and with a known address in the Netherlands. These individuals were invited for re-evaluation. The primary endpoint was the number of patients successfully re-linked to care. Results: Retrieval was implemented in 45 sites in the Netherlands. Of 20,183 ever-diagnosed patients, 13,198 (65%) were known to be cured or still in care and 1,537 (8%) were LTFU and eligible for retrieval. Contact was established with 888/1,537 (58%) invited individuals; 369 (24%) had received prior successful treatment elsewhere, 131 (9%) refused re-evaluation and 251 (16%) were referred for re-evaluation. Finally, 219 (14%) were re-evaluated, of whom 172 (79%) approved additional data collection. HCV-RNA was positive in 143/172 (83%), of whom 38/143 (27%) had advanced fibrosis or cirrhosis and 123/143 (86%) commenced antiviral treatment. Conclusion: Our nationwide micro-elimination strategy accurately mapped the ever-diagnosed HCV population in the Netherlands and indicates that 27% of LTFU HCV-infected patients re-linked to care have advanced fibrosis or cirrhosis. This emphasizes the potential value of systematic retrieval for HCV elimination.

Original languageEnglish
Pages (from-to)93-97
Number of pages5
JournalEuropean Journal of Internal Medicine
Publication statusPublished - Jul 2022


  • Linkage to care
  • Micro-elimination
  • People who inject drugs
  • Viral hepatitis
  • Lost to Follow-Up
  • Hepacivirus/genetics
  • Antiviral Agents/therapeutic use
  • Hepatitis C/epidemiology
  • Humans
  • Liver Cirrhosis/drug therapy
  • Hepatitis C, Chronic/drug therapy
  • Netherlands/epidemiology


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