Using the Diabetes Care System for a County-Wide Hepatitis C Elimination: An Integrated Community-Based Shared Care Model in Taiwan.

Abstract

INTRODUCTION:

Despite the serious risks of diabetes with hepatitis C virus (HCV) infection, this preventable comorbidity is rarely a priority for HCV elimination. We aim to examine how a shared care model could eliminate HCV in patients with diabetes (PwD) in primary care.

METHODS:

There were 27 community-based Diabetes Health Promotion Institutes in each township/city of Changhua, Taiwan. PwD from these institutes from January 2018 to December 2020 were enrolled. HCV screening and treatment were integrated into diabetes structured care through collaboration between diabetes care and HCV care teams. Outcome measures included HCV care continuum indicators. Township/city variation in HCV infection prevalence and care cascades were also examined.

RESULTS:

Of the 10,684 eligible PwD, 9,984 (93.4%) underwent HCV screening, revealing a 6.18% (n = 617) anti-HCV seroprevalence. Among the 597 eligible seropositive individuals, 507 (84.9%) completed the RNA test, obtaining 71.8% positives. Treatment was initiated by 327 (89.8%) of 364 viremic patients, and 315 (86.5%) completed it, resulting in a final cure rate of 79.4% (n = 289). Overall, with the introduction of antivirals in this cohort, the prevalence of viremic HCV infection dropped from 4.44% to 1.34%, yielding a 69.70% (95% credible interval 63.64%-77.03%) absolute reduction.

DISCUSSION:

Although HCV prevalence varied, the care cascades achieved consistent results across townships/cities. We have further successfully implemented the model in county-wide hospital-based diabetes clinics, eventually treating 89.6% of the total PwD. A collaborative effort between diabetes care and HCV elimination enhanced the testing and treatment in PwD through an innovative shared care model.

• Authors: Tsung-Hui Hu, Dih-Ling Luh, Yo-Yu Tsao, Ting-Yu Lin, Chun-Ju Chang, Wei-Wen Su, Chih-Chao Yang, Chang-Jung Yang, Hung-Pin Chen, Pei-Yung Liao, Shih-Li Su, Li-Sheng Chen, Tony Hsiu-Hsi Chen, Yen-Po Yeh, Changhua Hepatitis C Elimination Task Force
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 119 Issue 5 Pg. 883-892 (May 01 2024) ISSN: 1572-0241 [Electronic] United States
• PMID: 38084857 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

Chemical References

• Antiviral Agents

Topics

• Humans
• Taiwan (epidemiology)
• Male
• Female
• Middle Aged
• Delivery of Health Care, Integrated (organization & administration)
• Aged
• Hepatitis C (epidemiology, therapy)
• Diabetes Mellitus (epidemiology, therapy)
• Adult
• Primary Health Care (organization & administration)
• Prevalence
• Disease Eradication (organization & administration, methods)
• Mass Screening (methods, organization & administration)
• Antiviral Agents (therapeutic use)
• Community Health Services (organization & administration)