RE-LIVE study (Re-Linkage to Pan-Viral hepatitis): interim results from a multicenter observational study on care engagement in chronic viral hepatitis

초록

Background and aims: Despite highly effective antiviral therapies, linkage to care remains a key barrier to the global elimination of viral hepatitis. A considerable proportion of individuals with chronic viral hepatitis remain undiagnosed, and untreated, sustaining the burden of disease and transmission. This study aimed to evaluate systematic re-linkage strategies to re-engage these individuals in the continuum of care, with the goal of improving clinical outcomes and contributing to public health objectives. Method: A retrospective chart review was conducted at four tertiary academic hospitals in Korea to identify candidates for antiviral treatment. HBV eligibility included (i) non-cirrhotic patients with HBV DNA >2,000 IU/mL and fibrosis stage ≥2, and (ii) cirrhotic patients with any detectable HBV DNA. For HCV, partially diagnosedbut-untreated (DBU) cases were defined as anti-HCV antibody positive with missing HCV RNA data; completely DBU cases were HCV RNA positive without prior antiviral therapy. HBV patients eligible for HDV screening underwent HDV PCR. All identified patients were re-contacted via text or phone for re-evaluation and potential treatment linkage. Results: Among 2,810 patient charts reviewed, 33 HBV and 127 HCV patients were enrolled in the call-back program. Among HBV patients, 21.2% (7) responded and agreed to further evaluation; 6.1% (2) initiated antiviral therapy, while 78.8% (26) did not respond to call-back. Of 92 partial HCV DBU cases, 13.0% (12) agreed to evaluation, 3.3% (3) had prior treatment, 3.3% (3) sought care elsewhere, 2.2% (2) refused, and 78.3% (72) did not respond. Among them, 2.2% (2) initiated treatment. Among 35 complete DBU cases, 2.9% (1) agreed to evaluation, 2.9% (1) sought care elsewhere, 5.7% (2) refused, and 88.6% (31) did not respond; only 2.9% (1) initiated treatment. HDV RT-PCR was performed in 618 chronic HBV patients; 0.1% (1) tested positive but declined further management. In total, 3.1% (5) of 160 patients identified through the call-back program initiated antiviral therapy. Conclusion: Although effective antiviral treatments and expanded eligibility criteria are now available, many patients with viral hepatitis remain disconnected from care. Our re-linkage efforts showed limited success in bringing patients back into the treatment pathway. These findings emphasize the need for continued, practical strategies to improve access to care and support national and global goals for viral hepatitis elimination.