Authors:
Chen HS1, Hsu SM1, Luo YX1, Liu CL1, Cheng KP1, Ho TY1, Lin SH1, Wang PH2, Hsu TH2, Hsieh PC2, Lin LJ3, Shen CF3
1Hepatitis B & C Prevention and Control Office, Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan, 2Cancer Prevention and Control Division, Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan, 3Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
Background:
Given the high prevalence of hepatitis C among inmates and its high overlap with people who inject drugs, there is a strong focus on eliminating hepatitis C in correctional institutions. Nationwide outreach programs for HCV screening, diagnosis, and treatment were launched at these facilities in Taiwan between 2021 and 2025. The performance of these programs has yet to be evaluated.
Objectives:
Nationwide outreach programs within correctional institutions in Taiwan will be divided into two periods from 2021 to 2025. This study aims to evaluate the performance of programs in each time period.
Methods:
The Phase I program was implemented in 2021-2022 to assess feasibility and establish operational procedures. Inmates with at least six months remaining in their sentence are eligible for health education, anti-HCV testing, HCV RNA testing, and DAA treatment. This effort is coordinated by the Taiwan National Hepatitis C Program Office of the Ministry of Health and Welfare (MOHW), the Agency of Corrections of the Ministry of Justice, and local health bureaus, in collaboration with contracted hospitals, regional branches of the National Health Insurance Administration (NHIA), and non-governmental, non-profit organizations (NGO/NPO). To scale up efforts to eliminate Hepatitis C, the Phase II program was launched in August 2023 by the Health Promotion Administration (HPA) of the MOHW, in cooperation with the Agency of Corrections of the Ministry of Justice, the NHIA, local health bureaus, and contracted hospitals. Inmates older than 18 years will be eligible; focus on inmates who have shorter sentences and strengthen the willingness of inmates to attend the program. Health education, anti-HCV screening, HCV RNA testing, and DAA treatment will be provided to those who consent to testing and treatment. Each contracted hospital develops a tailored elimination plan and reports pertinent details of each period.
Results:
Out of 46 correctional institutions, 40 in Phase I and 42 in Phase II had established a hepatitis C elimination team and implemented a tailored elimination plan. In the Phase I and Phase II programs, 34,763 and 57,365 were invited to participate and receive health education, respectively. Of those invited, 17,197 (49.5%) and 37,538 (65.4%) agreed to undergo anti-HCV testing, revealing positivity rates of 27.4% and 14.7%, respectively. Among the anti-HCV-positive inmates, 4,026 (86.1%) and 4,246 (77.1%) received HCV RNA testing, which showed viremic rates of 60.1% and 51.5%, respectively. In those inmates, 83.3% and 81.9% received DAA, respectively.
Conclusion:
As a result of implementing the two-phase programs, most correctional institutions have now established the capacity to provide on-site screening, diagnosis, and DAA treatment. Moreover, the number of inmates who agreed to undergo anti-HCV testing increased, and the rates of anti-HCV-positive and viremic have decreased; this might be a step toward achieving Hepatitis C elimination.