LAUSR

Objectives Hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. Tzukuan, located in the southwestern area of Taiwan, is an HCV hyperendemic area (>30%). This study aimed to assess the changing epidemiological characteristics of HCV infection and to evaluate the long-term outcomes after the implementation of public health strategies for two decades. Design A population-based retrospective cohort study. Setting A comprehensive care programme was implemented, namely COMPACT Study, in Tzukuan since 1997. Participants A total of 10 714 residents participated the screening. Outcome measures The HCV status, demographic and clinical profiles of the participants were recorded and validated annually from 2000 through 2019. Results The HCV infection prevalence rates were 21.1% (1076/5099) in 2000–2004, 18.8% (239/1269) in 2005–2009, 14.1% (292/2071) in 2010–2014 and 10.3% (234/2275) in 2015–2019 (p for trend test <0.0001). Among them, 1614 underwent repeated tests during the follow-up period. The annual incidence rates were 0.54% in 2005–2009, 0.4% in 2010–2014 and 0.22% in 2015–2019, respectively (p=0.01). In addition to old age, lower education level was a major risk factor for HCV infection across different periods. HCV infection prevalence rate among those illiterates reached 40.9%, followed by 28.5% in those with elementary school level, and <10% in those with high school or higher levels. The major risk factor has shifted from iatrogenic exposure in 2000–2009 to household transmission after 2010. Conclusions HCV infection has been decreasing and the epidemiological features are changing in the hyperendemic area by continuing education, prevention and treatment strategies.