Hepatitis B Re-Engagement Program Highlights Data, Access Gaps: Helen Nde, MPH

In the third installment of her interview with The American Journal of Managed Care^®, Helen Nde, MPH, of the Center for Disease Analysis Foundation (CDAF), discussed remaining gaps in US hepatitis B re-engagement efforts and shared preliminary results from a national outreach program attempting to address them, as discussed at the European Association for the Study of the Liver Congress in May 2026.

Gaps in Hepatitis B Care and Re-Engagement

Nde said the US has not yet made full use of the tools and resources available to support people living with hepatitis B, particularly those who fall out of care. She identified the central issue as a lack of consensus on what it actually means for a patient to be "not in care" for hepatitis B; the definitional gap has direct consequences for treatment eligibility criteria. Providers themselves are sometimes unsure whether a patient should be started on treatment, according to Nde, underscoring a need for education at both the provider and patient levels about what a positive hepatitis B polymerase chain reaction test requires clinically.

Beyond education, she emphasized the need to operationalize proactive identification of at-risk patients within routine care, rather than waiting until they are already lost to follow-up before intervening. Nde also raised the importance of addressing stigma among the vulnerable populations disproportionately affected by hepatitis B, as well as the broader challenge of insurance instability, given that the disease requires lifelong monitoring, testing, and treatment.

Outreach Program Shows Early Signals on Re-Engagement

Nde then detailed the nationwide CDAF-Relink program, built on the premise that eliminating hepatitis B and C in the US requires looking backward to identify patients lost to follow-up, not only expanding forward-looking screening. The initiative has completed 4 rounds of funding and supports 43 grantees, she noted, spanning community clinics, academic health centers, hospital systems, federally qualified health centers, nonprofits, and health departments, targeting approximately 30,000 individuals believed to be lost to follow-up for hepatitis B.

Two years of preliminary data, spanning January 2024 to 2025, show that many patients presumed lost to follow-up have outdated records. Closer review finds some have cleared the virus, are already receiving care elsewhere, or have died. In addition, outdated contact information remains a major outreach barrier, as only about half of patients confirmed eligible for outreach can be reached; of those, an estimated 20% to 30% are already in care or have opted out of treatment. However, almost all patients who want care attend their first provider visit once informational and process barriers are cleared, Nde said.

She noted that the scope of her review ends at that first provider visit, meaning retention in care, which she called the larger and more difficult piece of the puzzle, remains an open question for future work.

"We're learning a lot, especially about what it takes to perform this outreach, the data requirements, the process requirements, and the system requirements,” Nde concluded. “I think it's been a very informative exercise, and the final results will definitely shed more light.”