Missed opportunities in HCV-RNA testing and linkage to care among anti-HCV-positive patients: a five-year retrospective hospital-based study

Hepatitis C virus infection remains a significant public health problem due to losses in the diagnosis and treatment cascade. In this study, we aimed to evaluate the HCV-RNA testing rate, the frequency of viremia, access to antiviral treatment, and the re-engagement of patients lost to follow-up into healthcare services through telephone contact among anti-HCV positive patients. This retrospective, single-center study included anti-HCV positive patients aged ≥18 years screened between 31.10.2019 and 31.10.2024. HCV-RNA results, treatment status, survival data, and clinic distribution were evaluated via the hospital information system. Patients without HCV-RNA testing or those untreated despite HCV-RNA positivity were contacted by telephone and invited to the outpatient clinic. Of 220,516 screened individuals, 1,492 were anti-HCV positive (0.68%; 95% CI, 0.64–0.71). Among these, 406 were HCV-RNA positive (27.2%; 95% CI, 25.0–29.5), 550 were HCV-RNA negative, and 536 had not undergone HCV-RNA testing (35.9%; 95% CI, 33.5–38.4). Surgical clinics accounted for the highest proportion of non-testing (45.9%). Of 142 patients planned for telephone outreach, 68 were reached (47.9%; 95% CI, 39.8–56.1), and 42 attended the outpatient clinic (29.6%; 95% CI, 22.7–37.5). HCV-RNA positivity was detected in 9 attendees, all of whom initiated antiviral treatment. Substantial losses were observed in the HCV care cascade, particularly at the confirmatory HCV-RNA testing stage. Reflex HCV-RNA testing and automated hospital-based alert systems may help improve linkage to care. Telephone-based re-engagement appeared feasible for reconnecting selected patients lost to follow-up, although its effectiveness requires confirmation in comparative studies. Strategies addressing healthcare access barriers among foreign-national patients may also help reduce losses in the care cascade.