The Journey to Hepatitis C Elimination in Taiwan: Insights From the Hemodialysis Population

Background: Hemodialysis patients are a priority population for hepatitis C virus (HCV) elimination in Taiwan, where HCV prevalence and end-stage kidney disease burden are high. The introduction of direct-acting antivirals (DAAs) has accelerated elimination efforts. This study evaluated HCV care cascade and identified gaps among Taiwan's hemodialysis patients in the DAA era. Methods: We conducted a retrospective cohort study using National Health Insurance Research Database from 2015 to 2021. Adult patients receiving long-term hemodialysis were included. HCV infection was defined as positive RNA test, and treatment initiation as receipt of ≥7 days of DAA therapy. We assessed the care cascade, annual and cumulative treatment rates, and disparities by demographic and facility characteristics. Results: Among 14 755 HCV antibody-positive patients, 48.2% underwent confirmatory RNA testing. Of 4783 viremic patients, 73.4% initiated DAA therapy. The greatest attrition occurred at the RNA confirmation step. Testing rates were lower among males (47% vs 50% in females), older adults, patients treated in tertiary hospitals (46%), and those in metropolitan areas (48% vs 52% rural). Regional variation was substantial, ranging from 38% to 41% in Eastern, Central, and Taipei regions to 67% in Southern Taiwan. Annual treatment initiation rose from 3.0% in 2017% to 50% in 2019, and then declined to 33% in 2021. Cumulative treatment increased from 10% before 2018% to 73.4% by 2021. Conclusions: HCV care among hemodialysis patients in Taiwan has improved substantially in the DAA era. The major barrier is incomplete RNA testing. Addressing this gap is essential to sustain progress and achieve HCV elimination in this high-risk population.