Progress Towards Hepatitis C Eradication in Taiwan's Hemodialysis Patients

Overview

In Taiwan, significant progress has been made toward hepatitis C virus (HCV) elimination among hemodialysis patients through expanded access to direct-acting antivirals (DAAs). Despite improvements, major gaps remain in confirmatory RNA testing, which limits treatment initiation and overall elimination efforts.

Background

Hepatitis C virus infection poses a major health challenge globally and in Taiwan, where the burden of end-stage kidney disease is the highest worldwide. Taiwan has implemented a national strategy aiming to eliminate HCV by 2025, focusing on early detection and broad DAA access. Hemodialysis patients represent a priority group due to their high HCV prevalence and vulnerability. The introduction of DAAs and decentralized care models have accelerated treatment uptake in this population.

Data Highlights

Key Findings

• Only 48.2% of HCV antibody-positive hemodialysis patients underwent confirmatory RNA testing, representing the largest gap in the care cascade.
• Among viremic patients, 73.4% initiated DAA therapy, indicating good treatment uptake once diagnosis is confirmed.
• RNA testing rates were lower in males, older adults, tertiary hospitals, and metropolitan areas compared to females, younger patients, non-tertiary hospitals, and rural areas.
• Significant regional disparities exist, with Southern Taiwan achieving the highest RNA testing rate (67%) compared to 38-41% in other regions.
• Annual treatment initiation increased sharply from 3.0% in 2017 to 50% in 2019, but declined to 33% in 2021.
• Cumulative treatment coverage improved substantially from 10% before 2018 to 73.4% by 2021, reflecting progress in the DAA era.

Clinical Implications

Clinicians should prioritize confirmatory RNA testing in hemodialysis patients with positive HCV antibody results to ensure timely treatment initiation. Addressing demographic and regional disparities in testing and treatment access is essential to sustain elimination efforts. Integration of HCV care into routine dialysis services and continued decentralization of DAA prescribing can further improve outcomes in this high-risk population.

Conclusion

Taiwan has made substantial strides in HCV microelimination among hemodialysis patients through expanded DAA access and targeted programs. However, incomplete RNA testing remains the critical barrier to achieving full elimination in this vulnerable group.

References

1. Taiwan National Health Insurance Research Database Studies 2015-2021 -- HCV Care Cascade in Hemodialysis Patients
2. Changhua Integrated Program to Stop HCV Infection (CHIPS-C) -- Microelimination Success in Dialysis Patients
3. ERASE-C Campaign -- Mass Screening and On-site Treatment in Southern Taiwan
4. World Health Organization 2016 -- Global HCV Elimination Goals