Hepatitis C micro-elimination in people who inject drugs: Incarcerated or methadone maintenance therapy in Taiwan

People who inject drugs (PWID) are among the populations most heavily infected by hepatitis C virus (HCV) infection. Taiwan has implemented targeted strategies to pursue HCV micro-elimination in this high-burden group. Universal screening combined with on-site direct-acting antiviral therapy has been carried out in Yunlin and Penghu prisons, achieving a sustained virologic response rate of 100 % in per-protocol analysis. Critical factors underlying this success included strong collaboration with the Ministry of Justice's Agency of Corrections, comprehensive universal screening, and immediate treatment within the correctional setting. In the community, a collaborative care model was introduced in Changhua County to address HCV among marginalized populations, including PWID, people living with human immunodeficiency virus, prisoners, and those undergoing methadone maintenance therapy. This model achieved both high screening and treatment uptake rate, demonstrating that successful elimination requires highly integrated approaches. Ideally, such programs should be coordinated by public health authorities in partnership with healthcare providers to ensure concurrent delivery of screening and treatment across all potential contact points with PWID. Taiwan's experience with prison-based elimination programs and community-based integrated care provides valuable insights and practical strategies for advancing HCV micro-elimination efforts among PWID worldwide.