The cascade of care model, often used to assess HIV and hepatitis C virus (HCV) health service delivery, has limitations in capturing the complexities of patient engagement. This study examined the dynamic engagement and mortality patterns among people with HIV and HCV using data from the Canadian HIV-HCV Co-Infection Cohort, which tracks 2098 participants from 18 centers biannually. Researchers used Markov multistate models to analyze transitions between five states: lost-to-follow-up (LTFU), reengaged, withdrawn from the study, death, and engaged-in-care. The study included 1809 participants contributing 12,591 person-years from 2003 to 2022.

Findings revealed that 46% of participants experienced at least one episode of LTFU, with only 57% reengaging. During the study, 383 participants (21%) died, and those who were LTFU had double the mortality risk compared to those consistently engaged in care. Factors leading to LTFU included detectable HCV RNA, incomplete HCV treatment, and recent incarceration. Indigenous participants had higher mortality rates across all engagement trajectories. The study underscores the need for targeted strategies to reengage and treat individuals who are LTFU to improve outcomes and advance HCV elimination efforts.

Reference: Saeed S, Thomas T, Dinh DA, et al. Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study. Open Forum Infect Dis. 2024 Apr 25;11(5):ofae239. doi: 10.1093/ofid/ofae239. PMID: 38798898; PMCID: PMC11127478.