Best Practices to Reengage Lost Hep B Patients: Helen Nde, MPH

Re-engaging patients with hepatitis B who are lost to follow-up is a viable strategy to support global elimination goals, but success depends heavily on how closely outreach connects with patients, explained Helen Nde, MPH, of the Center for Disease Analysis Foundation, who participated in a scoping review presented at the European Association for the Study of the Liver.

The scoping review analyzed 11 studies published between 2015 and 2025 that focused on identifying and re-engaging people living with hepatitis B who were lost to follow-up. Conducted across 7 countries and 3 World Health Organization regions, the review found that the vast majority of studies came from high-income countries.

Re-engagement rates varied dramatically from just 2% in the Netherlands to 100% in Australia and Ireland, which highlighted that program design and legal context can significantly shape outcomes. The researchers concluded that while re-engagement can support hepatitis B elimination, data management systems must improve to reduce outreach ineligibility and contact failure.

Active vs Passive Outreach: 2 Approaches, Different Trade-offs

Nde told The American Journal of Managed Care^® that the wide variation in outcomes reflects 2 fundamentally different outreach philosophies. The Netherlands’ low re-engagement rate was driven largely by legal constraints. At the time of the study, Dutch law prohibited direct patient outreach and required contact with the patients' general practitioners instead, who followed up with patients. That additional layer “introduced friction” and made it harder to reach patients who had moved or changed contact information, she said.

However, the benefit of this outreach was that it was proactive through phone calls, text messages, and even letters.

“The most effective way to carry out that kind of outreach we found is in-person outreach, peer-to-peer outreach, [and] outreach by navigators who have built trust in the community,” Nde said.

By contrast, Australia and Ireland used an opportunistic, passive model: patients coming into the emergency department (ED), whether the reason was related to hepatitis or not, were identified on-site and linked to hepatitis care. While those programs worked with smaller patient populations, the proximity to the patient proved decisive. The disadvantage of this more passive approach is that the patient is only caught if they come into the ED. The advantage is that once they are in the ED, it’s easy to link them to care and provide a warm handoff.

"The general theme that emerges is the closer you get to the patient, the better it is for successful re-engagement," Nde said.