Experience Sharing: Micro-elimination of HCV infection in the rural and remote areas of Taiwan
Populations living in mountains and rural areas in Taiwan have a higher rate of HCV and liver-related mortality rate. The inconvenience of transportation and unfamiliarity with the referral hospitals are the barriers to HCV screening and healthcare resources.
The micro-elimination of HCV approach is a strategy aiming toward a specific at-risk population. This program experience shared the results of implementing a multidisciplinary care team in 4 HCV high-epidemic rural townships in Taiwan, including the HCV screening, link-to-care, and success rates of DAA treatment.
- 8 patients (1.3%) discontinued treatment, no case was related to DAA therapy.
- The most frequent adverse events were fatigue/malaise, headache, diarrhea, dizziness, and pruritus.
- The presence of HCC at enrollment was the only factor significantly associated with treatment failure (P < 0.01).
The outreach decentralized community-based care system with DAA therapy was highly effective and safe in the achievement. Notably, 96.1% of DAA-treated patients achieved SVR12, with overall community effectiveness of 80.7%.
Even in townships in rural/remote areas, HCV micro-elimination program demonstrated improved access to DAA and reduced barriers to HCV treatment, which could help us to tackle the disparity.
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HCV micro-elimination in prison Outreach onsite treatment with pangenotypic DAA Prisoners are at high risk of HCV infection, with prevalence rates ranging from 3.1% to 38%. Because HCV is readily transmitted through injection drug use, and individuals with substance use disorders are often incarcerated, there is a high prevalence of HCV infection in correctional setting. The anti-HCV prevalence rate could be as high as 91% among incarcerate people who inject drugs (PWID). Therefore, incorporating correctional settings into HCV elimination plans are of importance to reduce the burden of HCV infection.
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Experience Sharing: HCV‑HELP study Hepatitis C Virus in‑hospital micro elimination program Well-designed strategies can effectively prevent the spread of HCV. Measurements included efficient tests and diagnosis, large-scale screening programs and easily-accessed HCV care cascade.The HCV in-hospital elimination program (HCV-HELP) is to eliminate HCV, reduced hazards and provide a safe hospital environment for public and hospital staff members.
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Experience Sharing: Micro-elimination of Hepatitis C virus infection in hemodialysis centers (ERASE-C) Hepatitis C virus (HCV) infection is prevalent in patients undergoing maintenance hemodialysis and can be attributed to the nosocomial transmission in hemodialysis centers. Due to the highly prevalent and contiguous property in the close-contact environment, and the lack of an available vaccine, the strategy of ‘treatment as prevention’ is imperative for the control of HCV infection in the uremic hemodialysis population. ERASE-C program implements a universal outreach screening strategy, followed by either link-to-care or decentralized on-site treatment in 18 hemodialysis centers, in order to achieve micro-elimination of HCV for uremic patients in hemodialysis centers.
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Experience Sharing: Hepatitis C Virus Reflex Testing A thorough HCV care cascade involves proper screening, confirmation of the presence of HCV RNA, and linking patients to medical care. The multistep testing procedure represents barriers to HCV care. HCV reflex testing is a strategy that simplifies the diagnostic algorithms. Namely, the laboratory performs anti-HCV testing first, if the result is positive, the laboratory will immediately perform an HCV RNA test on the same blood sample. Reflex testing obviates the need for the patient to return for follow-up testing should the initially HCV antibody test be reactive. Implementation of reflex testing enables timely and accurate diagnosis of HCV.