Clinical Scorecard: Progress Towards Hepatitis C Eradication in Taiwan: Perspectives from the Hemodialysis Patient Group
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection in hemodialysis patients
Key Mechanisms
Direct-acting antivirals (DAAs) for HCV treatment; RNA testing for infection confirmation
Target Population
Adult hemodialysis patients in Taiwan with HCV infection
Care Setting
National Health Insurance system with decentralized care including tertiary hospitals, local health facilities, and hemodialysis units
Key Highlights
Among 14,755 HCV antibody-positive hemodialysis patients, only 48.2% underwent confirmatory RNA testing, representing the major gap in the care cascade.
Of 4,783 viremic patients, 73.4% initiated DAA therapy, with cumulative treatment rates rising from 10% before 2018 to 73.4% by 2021.
Treatment initiation rates increased sharply from 3.0% in 2017 to 50% in 2019, then declined to 33% in 2021; regional and demographic disparities in testing and treatment exist.
Guideline-Based Recommendations
Diagnosis
Perform anti-HCV antibody screening for hemodialysis patients.
Confirm HCV infection with RNA testing following positive antibody results to reduce attrition in care.
Management
Initiate DAA therapy promptly for viremic hemodialysis patients to improve treatment uptake and outcomes.
Decentralize HCV care to include nonspecialist providers and local health facilities to enhance access.
Monitoring & Follow-up
Use national surveillance data to monitor HCV care cascade progress and identify gaps.
Track annual and cumulative treatment initiation rates among hemodialysis patients.
Risks
Recognize that incomplete RNA testing is a major barrier to HCV elimination in this high-risk population.
Address disparities in testing and treatment related to sex, age, hospital type, and geographic region.
Patient & Prescribing Data
Adult hemodialysis patients with confirmed HCV infection in Taiwan
DAA therapy uptake increased substantially after policy expansion and decentralization; nonspecialist physicians increasingly prescribe DAAs; financial barriers removed by National Health Insurance coverage.
Clinical Best Practices
Integrate HCV screening and treatment into routine hemodialysis care and local health services.
Implement targeted microelimination programs such as CHIPS-C and ERASE-C to improve treatment rates.
Empower nonspecialist healthcare providers through education to prescribe DAAs and manage HCV.
Ensure universal coverage of HCV diagnostics and treatment to eliminate financial barriers.
Address regional and demographic disparities by tailoring outreach and care delivery strategies.
