Study design
deaths, comorbidity, HBV and HIV tests
LIVER FIBROSIS, HIV COINFECTION
Microbiology data files from patients seen between 2005 and 2018 at our tertiary center (Hospital Universitario de Canarias), which serves a population of ~400,000 subjects, were retrospectively reviewed. From all the cases with positive HCV antibodies, we identified those with positive HCV antibodies but without RNA investigation, therefore, unknown RNA.After excluding deaths from potential candidates for reengagement, we included those fulfilling the following criteria: older than 18 years old, without regular (at least once a year) specialist (internal medicine or hepatology) follow-ups, without HIV coinfection, nondependent people for daily living activities, with enough data available to be contacted (by phone and mail), and those who remain in our health care area. The contact information was gathered from the administrative data records of the patients, which are usually updated after any health-related consultation, including routine blood tests. When the residency address was no longer in our catchment health area, the patient was considered moved to another health area.Randomization in a 1:1 ratio (ClinicalTrials.gov, Number NCT04153708) was stratified by age and sex, undertaken in blocks of 50 patients, and assigned to any of the following 2 strategies: (1) phone call contact (up to 3 call attempts at different times from inside the hospital) to provide patients with an appointment or (2) mailed invitation letter with a scheduled appointment 10–14 days after receiving the letter. The letters and phone calls were carried out by nonmedical staff (administrative staff). Twenty letters were posted every week, and ~30 calls per day (3 d per week) were performed. In both strategies, the patient was informed about an abnormal laboratory finding and the need to schedule an appointment with a hepatologist for further evaluation. The information given was the same in both strategies, with scarce details in accordance with confidentiality. In addition, in cases where an answering machine or voicemail was encountered, no message was delivered. The letter content and the script used in the phone calls are available as Supplemental Material 1 and 2 (The number of phone calls needed to contact patients, wrong numbers, nonanswered calls, and returned-to-sender letters were registered. All patients had free access to the health care system called “Seguridad Social” in Spain, without cost for visits, complementary tests, and treatment, if needed.We registered age, sex, mortality, comorbidity, social support, date of the first positive antibody screen for HCV, previous HBV and HIV tests, transaminases at the time of serology request, history of i.v. or inhaled drug use, and previous specialist evaluation (hepatology or internal medicine department).Patients who showed up for the appointment were informed about the aims of the study, and informed consent was obtained. Patients who attended the appointment were fully evaluated through a fast-track service, which included elastography (Fibroscan, Echosens, France) and treatment prescription on the same day of the visit; if blood tests were needed for RNA investigation, a second appointment was scheduled within 2 weeks.Liver fibrosis was assessed using elastography, treatment prescription, and laboratory variables, including RNA results and HBV/HIV status were recorded.