@article{df68561546a249f18ee83f8af5790d90,
title = "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 the spread of 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 Changhua County, Taiwan were treated using an interdisciplinary 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 3 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. Outcome: Outcome measures included quality indicators pertaining to 6 steps in HCV care ranging from HCV screening to treatment completion to cure. Analytical Approach: A descriptive analysis. Results: A total of 3,657 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 166 (96.0%) of 173 patients. 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.",
keywords = "Collaborative care, dialysis, direct-acting antivirals (DAAs), elimination, end-stage renal disease (ESRD), gastroenterology, HCV screening, hemodialysis clinic, hepatitis C, microelimination, nephrology, public health, quality improvement (QI)",
author = "{Changhua Hepatitis C Elimination Task Force} and Hu, {Tsung Hui} and Su, {Wei Wen} and Yang, {Chi Chieh} and Yang, {Chih Chao} and Kuo, {W. Hsien} and Chen, {Yang Yuan} and Yeh, {Yung Hsiang} and Chen, {Shiou Shiang} and Tsao, {Yu Yu} and Chen, {Kwei Ming} and Yan, {Sheng Lei} and Lai, {Jun Hung} and Yao, {Chih Da} and Lim, {Cherng Harng} and Jen, {Hsiao Hsuan} and Yeh, {Yen Po} and Chen, {Sam Li Sheng} and Chen, {Hsiu Hsi} and Chen, {Shih Chung}",
note = "Funding Information: This work was supported by the Changhua County Public Health Bureau; School of Oral Hygiene, College of Oral Medicine, Taipei Medical University; Department and Graduate Institute of Health Care Management, Chang Gung University; Department of Health Industry Management, Kainan University; and Division of Gastroenterology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital. This work also was supported by the “Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health , National Taiwan University” from the Featured Areas Research Center Programme within the framework of the Higher Education Sprout Project by the Ministry of Education ( MOE ) in Taiwan. The funders had no role in the study design, analysis, reporting, or decision to submit the manuscript for publication. Funding Information: Hsu-Heng Yen is a member of the Changhua Hepatitis C Elimination Task Force, in addition to authors Hu, H.-H. Chen, Su, C.-Chao Yang, Kuo, K.-M. Chen, Y.-Y. Chen, Lai, and Yan. Tsung-Hui Hu, MD, PhD, Wei-Wen Su, MD, Chi-Chieh Yang, MD, Chih-Chao Yang, MD, W-Hsien Kuo, MD, Yang-Yuan Chen, MD, Yung-Hsiang Yeh, MD, Shiou-Shiang Chen, BN, Yu-Yu Tsao, BPH, Kwei-Ming Chen, MD, Sheng-Lei Yan, MD, PhD, Jun-Hung Lai, MD, Chih-Da Yao, MD, Cherng-Harng Lim, MD, Hsiao Hsuan Jen, PhD, Yen-Po Yeh, MD, PhD, Sam Li-Sheng Chen, PhD, Hsiu-Hsi Chen, PhD, and Shih-Chung Chen, DDS. This is the first article from the Changhua Integrated Program to Stop HCV Infection (CHIPS-C). Study conception: T-HH, W-WS, Y-PY, SL-SC; study design: T-HH, W-WS, Y-PY; literature research: T-HH, W-WS, Y-PY; clinical studies: W-WS, C-ChiehY, C-ChaoY, W-HK, Y-YC, Y-HY, S-SC, Y-YT, K-MC, S-LY, J-HL, C-DY, C-HL, HHJ, S-CC; data acquisition: S-SC, Y-YT, Y-PY; data analysis: S-SC, Y-YT, HHJ, YP-Y; statistical analysis: S-SC, Y-YT, HHJ, Y-PY; guidance regarding the build-up of community-based collaborative care model: Y-PY, HHC, T-HH; supervision or mentorship: T-HH, W-WS, Y-PY, HHC. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This work was supported by the Changhua County Public Health Bureau; School of Oral Hygiene, College of Oral Medicine, Taipei Medical University; Department and Graduate Institute of Health Care Management, Chang Gung University; Department of Health Industry Management, Kainan University; and Division of Gastroenterology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital. This work also was supported by the ?Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University? from the Featured Areas Research Center Programme within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. The funders had no role in the study design, analysis, reporting, or decision to submit the manuscript for publication. The authors declare that they have no relevant financial interests. The authors express special thanks to the administrative support of Changhua County Government, Taiwan, and National Health Insurance Administration, Ministry of Health and Welfare, Taiwan, and the physicians at Changhua Christian Hospital, Show Chwan Memorial Hospital, Changhua Hospital, Yuan Sheng Hospital, Yuanlin Christian Hospital, Chang Bing Show Chwan Memorial Hospital, Erilin Christian Hospital, Lukang Christian Hospital, and Changhua Public Health Bureau, for their assistance in the study. Received September 23, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form March 18, 2021. Publisher Copyright: {\textcopyright} 2021 The Authors",
year = "2021",
month = oct,
doi = "10.1053/j.ajkd.2021.03.017",
language = "English",
volume = "78",
pages = "511--519.e1",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders",
number = "4",
}
