Elimination of Hepatitis C Virus in a Dialysis Population: A Collaborative Care Model in Taiwan.

Abstract Rationale & Objective Hemodialysis facilities are high-risk environments for hepatitis C virus (HCV). Eliminating HCV from all dialysis facilities in a community may be achieved more effectively under a collaborative care model. Study Design Quality improvement study of multidisciplinary collaborative care teams including nephrologists, gastroenterologists and public health practitioners. Setting & Participants All dialysis patients in the Changhua county of Taiwan were treated using an inter-disciplinary collaborative care model implemented within a broader Changhua-Integrated Program to Stop HCV Infection (CHIPS-C). Quality Improvement Activities Provision of an HCV care cascade to fill three gaps including screening and testing, diagnosis, and universal direct-acting antiviral (DAA) treatment implemented by collaborating teams of dialysis practitioners and gastroenterologists working under auspices of Changhua Public Health Bureau. Outcomes Outcome measures included quality indicators pertaining to six steps in HCV care ranging from HCV screening to complete treatment and cure from treatment with DAA Analytical Approach A descriptive analysis. Results A total of 3657 patients from 31 dialysis facilities were enrolled. All patients completed HCV screening. The DAA treatment initiation rate and completion rate were 88.9% and 94.0%, respectively. The collaborative care model achieved a cure rate of 96.0% (166/173). No virologic failure occurred. The cumulative treatment ratios for patients with chronic HCV infection increased from 5.3% before interferon-based therapy (2017) to 25.6% after restricted provision of DAA (2017-2018) and then to 89.1% after universal access to DAA (2019). Limitations Unclear impact of this collaborative care program on incident dialysis patients entering dialysis facilities each year and on patients with earlier stages of chronic kidney disease. Conclusions A collaborative care model in Taiwan increased the rates of diagnosis and treatment for HCV in dialysis facilities to levels near those established by the World Health Organization.