Toward Hepatitis C Elimination in Marginalized Populations by a Collaborative Multi-setting Approach

Abstract

Abstract Background: Treating marginalized populations with hepatitis C presents a difficult challenge in achieving the 2025 goal of hepatitis C elimination in Taiwan. We report the novel experience of Changhua county in Taiwan in characterizing and treating these populations. Methods: The Changhua integrated program to stop HCV infection (CHIPS-C) adopted a multidisciplinary care approach within marginalized populations and enrolled patients from 2019 Jan to 2020 Dec. This model incorporated active collaboration between different teams with gastroenterologists, psychologists, infectious disease doctors, and nursing coordinators. Results: There were 303 patients who attended methadone clinics, 3222 persons in correctional institutions, 2853 persons within the national HIV surveillance program (noted as “People under surveillance program”), and 731 HIV-positive patients recruited during the study period. 25.41% (73/303) of methadone clinic patients, 17.65% (129/731) of HIV clinic patients, and 44.3% (41/93) of Group B (deferred prosecuted or probationary people under protective parole) within the “People under surveillance program” category were also recruited into other settings during this period of time. Patients in methadone clinics have the highest seroprevalence of HCV (86%), followed by prisoners (45.23%), patients who attended HIV clinics (35%), and patients within groups of the “People under surveillance program” category (2.94% to 59.52%). Overall, the HCV RNA positivity rate is 70% and the treatment rate is 85%. The proportions of RNA testing and treatment are similar among groups. Conclusion: Overlapping characteristics were observed in these populations which highlights that a simultaneous rapid scale-up of treatment was important in these cohorts to lead to HCV elimination.