Kracht PAM, et al. - When widespread implementation of universal direct-acting antivirals access has been realized, identification and treatment of the lost to follow-up (LFU) patients with hepatitis C virus (HCV) has become increasingly important to achieve final elimination. Researchers sought the reasons for previous loss to follow-up in cases with HCV who have been brought back into care. Through convenience sampling, inclusion was performed of 15 cases with HCV who were evaluated at the University Medical Center Utrecht Infectious diseases outpatient clinic as part of the “REtrieval And cure of Chronic Hepatitis C”-project in 2017. They participants underwent face-to-face semi-structured in-depth interviews. A qualitative analysis based on the grounded theory was applied on them. In patients with HCV who were LFU, they uncovered a basic socio- psychological process named “maintaining the achieved balance”. A transformative process following the initial HCV diagnosis resulted in this “achieved balance”. It is a steadfast stance in which participants keep HCV out of sight and in the margin of their lives in order to reestablish an optimal state of well-being. Repeated evasive behavioral patterns subsequently defended the balancing perspective to avoid confrontation with the disease. This study provide information concerning why individuals with HCV were not retained in care but also why they remained LFU thereafter. They recommend physicians to realize that this mindset can be persistent and repeated efforts may be required to ultimately trace and retrieve these patients.