Hepatitis patients lost to follow-up at a liver centre in a tertiary care hospital of Karachi, Pakistan — a cross-sectional descriptive study

Objective: To investigate the causes for loss-to-follow-up of hepatitis patients at a liver centre of a tertiary care hospital. Methods: A representative sample of 165 patients who were lost to follow-up during 2009 to 2010 was chosen and a cross-sectional descriptive study was performed. All hepatitis patients included were screened for antibody to hepatitis C virus (HCV Ab) and hepatitis B virus surface antigen (HbsAg), and were tested through polymerase chain reaction (PCR) and genotyping. Laboratory investigations, ultrasounds, personal habits, visits to hakeems and use of other alternative medications, occupations and income per month, education, and other basic information was also recorded. Those who did not return for follow-up were contacted and inquired about their reasons for loss-to-follow-up. Based on this data, the patients were categorised into four different groups according to reasons of loss to follow up: non-compliance, alternative medication, monetary issue and poor prognosis. Results: The entire sample size of 165 patients who were lost to follow-up was included in the study. 14 (8.5%) patients were hepatitis B virus (HBV) positive. Of these patients, 1(7.1%) was lost due to alternative medication and the rest (n=13; 92.9%) were lost to follow-up due to non-compliance. Amongst the 151 (91.5%) hepatitis C virus (HCV) positive patients, 2 (1.3%) were lost due to monetary issues, 17 (11.3%) were lost due to alternative medication, 4 (2.6%) were lost due to poor prognosis and 128 (84.8%) were lost due to non-compliance. Conclusion: This study shows that most patients were lost to follow-up due to non-compliance. It is important for physicians to design better counselling programmes to make the patient compliant enough to go through the complete treatment.