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HDV: Linkage to Care
Ensuring Linkage to Care for Patients Diagnosed With Hepatitis Delta Virus

Released: March 03, 2023

Expiration: March 01, 2024

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Key Takeaways
  • The goal of HDV care is to reduce the progression of liver disease.
  • A cornerstone of HDV care is repeated counseling to encourage self-efficacy and long-term engagement in care.
  • Retention in care depends on the engagement of both patients and the healthcare system.

The goal of care for people coinfected with hepatitis B and hepatitis D is to reduce liver-related disease. This is particularly important for this group of patients because, compared with hepatitis B monoinfection, coinfection with hepatitis D is associated with a more rapid progression of liver fibrosis and an increased risk of hepatocellular carcinoma.

Although diagnosing hepatitis D is an important first step in improving outcomes for these patients, if these patients are not linked to effective care following the diagnosis, their outcomes will not change. Furthermore, with new treatment options for hepatitis D virus (HDV) likely available soon, it is important for patients to have established care to access treatment when available. Here I discuss some strategies to help increase linkage to care rates for patients diagnosed with hepatitis D. 

Low Linkage to Care Rates for Patients With Hepatitis B Virus
Although data on linkage to care rates for patients with hepatitis D are relatively scarce, we can extrapolate from some recent hepatitis B data. Indeed, a recent systematic review showed that only about one third to just over one half of patients with hepatitis B virus (HBV) are effectively being linked to care. We, therefore, can assume that the rates of linkage to care among people with HDV are similar or perhaps even less. 

HDV Management: Impact on Linkage to Care
The HDV management paradigm is serial in nature and subject to multiple branches where the patient can be lost to follow-up. With these multiple steps come multiple opportunities for loss of patient engagement.

To combat this, we must emphasize in our patient counseling the importance of keeping up with the diagnostic and monitoring recommendations so that patients can make informed decisions with respect to following up with their healthcare professionals (HCPs). Indeed, I think it is very important to stress that we are recommending these tests because their risk of cancer is much higher than if they had HBV monoinfection, and if we find it early, we might have curative options.

Unfortunately, many of my patients are underinsured and the financial burden of getting an ultrasound every 6 months is very, very significant. For these patients, I strive to obtain at least 1 per year, but I know this is not optimal. 

Barriers Preventing Patients With HBV/HDV Coinfection From Engaging in Care
Recognizing the barriers preventing patients with HBV/HDV coinfection from engaging in care can help us to develop strategies to overcome them. The following are some identified barriers:

  • Stigma or feeling of shame and depression
  • Financial difficulties
  • Language barriers and cultural differences
  • Lack of familiarity with the healthcare system
  • Lack of access to an HCP with experience treating HDV

Interventions to Increase Retention in Care for Patients With HDV
Although we may not have the tools to overcome each barrier, we can start with some attainable strategies. One key step is encouraging patients to establish with their HCP and to keep follow-up appointments for monitoring labs and ultrasounds or treatment.

We know that knowledge can change health behaviors, so educating both patients and HCPs is also a key step. Of importance, this education must be delivered in a culturally and linguistically appropriate manner through outreach and education. Finally, education should be provided in various languages to try to engage populations at risk.

Your Thoughts?
How do you optimize linkage to care for your patients diagnosed with HDV? Join the discussion by posting a comment.