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 interferonbased therapy (2017) to 25.6% after restricted provision of DAA (2017DAA ( -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.Complete author and article information provided before references.

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Esophagogastroduodenoscopy (EGD) screening is currently suggested with a practice guideline for all cirrhosis patients, but the true EGD screening rate is low. Our study evaluates noninvasive variables—including liver stiffness (LS), spleen stiffness (SS), and spleen diameter—based on acoustic radiation force impulse (ARFI) sonography for noninvasive prediction of cirrhosis and esophageal varices (EVs). In our study, 118 patients (mean age 57.11 ± 11.23), who were classified into a cirrhosis group and a chronic liver disease group, were compared statistically on their blood data and ARFI sonography. To identify the most effective variable for noninvasive prediction of EVs, the cirrhosis group was further divided into two subgroups by the presence or absence of EVs. EV and non‐EV (NEV) patients were compared statistically using blood data, spleen diameter, LS, and SS. The LS cutoff value for predicting cirrhosis was determined as 1.64 m/s, which carried a sensitivity of 81.2% and a specificity of 93.9%. SS and spleen diameter met a significant difference for EV prediction. Spleen diameter with a cutoff value of 10.69 cm carried a sensitivity of 96.2% and a specificity of 56.3%; SS with a cutoff value of 2.82 m/s carried a sensitivity of 96.2% and a specificity of 50%. In our study, a new cutoff criterion composed of spleen diameter and SS was suggested as a better clinical tool for the screening of EVs.

The efficacy of tenofovir disoproxil fumarate (TDF) for previously nucleos(t) ide analogs (NA)-treated patients in Taiwan is limited. In this retrospective study, our aim is to evaluate the efficacy of TDF in chronic hepatitis B (CHB) with suboptimal response (SR) to non-TDF NA therapy. We retrospectively analyzed CHB patients with SR to non-TDF NA treatment, in Show Chwan Memorial Hospital, Changhua, Taiwan, from September 2011 to December 2018. The primary endpoint was defined as achieving complete virological response (CVR) during TDF therapy. Twenty-eight patients were included in this study. Sixteen (57.1%) patients achieved CVR at a median duration of 135 weeks of TDF therapy. Nine patients (32.1%) achieved CVR early at 24-weeks treatment. One patient developed virological breakthrough during TDF treatment, which was due to poor drug adherence. The remainders had marked HBV DNA virological suppression (HBV DNA < 1000 IU/mL) after TDF treatment. One patient had renal function deterioration after 144 weeks of TDF therapy. Three of 17 (17.6%) patients developed HBeAg seroconversion after TDF treatment. TDF monotherapy is a potent rescue therapy for CHB patients with SR to non-TDF NA. Closely monitor renal function is necessary especially in patient with renal dysfunction initially.