Making progress for patients of liver disease
Liver disease is a serious public health issue in Taiwan. In a population of over 23 million, roughly 15–20% of adults are hepatitis B viral (HBV) carriers, and 2–5% are infected with hepatitis C virus (HCV)1. To address these challenges, Taiwan has seen the rise of one of Asia’s most active and successful patient advocacy groups for liver disease. Known as the Gan Ji Hwei (Liver Disease Prevention and Treatment Research Foundation), it helps drive patient awareness and education. It also runs clinics and supports screening and treatment programmes, including in rural areas where many patients lack access to adequate quality care2.
Established in 1994, the Liver Disease Prevention and Treatment Research Foundation aims to eliminate liver diseases in Taiwan. Professor Yang Pei-Ming, Chief Executive Officer (CEO) explains why a patient-centric approach is critical to tackling liver diseases.
“Nearly 80% of liver cancer cases are associated with chronic HBV or HCV infection, so treating and controlling the disease course can help in its prevention. Empowering patients to manage their disease using the right knowledge and tools is transformative,” Prof Yang shares,
“Not only because patient awareness and education can help in managing liver diseases but because it can aid in reducing serious complications.”
Prof Yang, who is an emeritus professor of Internal Medicine at the National Taiwan University Hospital, and a pioneer in Taiwan’s fight against liver diseases, believes such an approach is equally essential in addressing the barriers that exist in rural areas.
Giving patients the power
“Whilst patient education is important, it’s even more critical in rural areas and yet much harder to do. Patient knowledge can be powerful because earlier diagnosis and treatment is a total game-changer. This is why being able to contact patients in harder-to- reach areas is an integral part of our mission to eliminate liver diseases.”
On being asked why Prof Yang feels so strongly about this, he says, “Many patients with chronic liver disease are symptomless and therefore unaware they have the disease. This results in a lack of motivation to get screened. In addition, there is a lack of awareness of the consequences and sequelae of chronic hepatitis viral infections or chronic liver diseases. By the time patients start to display symptoms and therefore seek treatment, they may already be in the advanced stages of the disease.”
“Diagnostic blood tests and ultrasound examinations are the key tools to diagnose liver diseases. Abnormally high serum AST or ALT levels may also indicate a need for treatment; therefore, it is important that such diagnostic tests are carried out. Raising awareness and encouraging screening can help to tackle this issue.”
The positive impact of patient advocacy and health policies
Since 2019, Taiwan’s health authorities have offered a HBV and HCV test for people aged 45–79 years, free of charge. For aboriginal people, this extends to those aged 40-79. Liver cancer had been previously the leading cause of cancer-related deaths in Taiwan, but due to dedicated efforts, the number of affected patients has gradually decreased and it has become the second leading cause since 2004. The annual incidence rate of liver cancer has now declined from the first before 2005 to the fourth since 2014. On the other hand, liver cirrhosis and chronic liver disease also declined from the sixth leading cause of death to the tenth since 2015 in Taiwan.
More recently, at the end of 2020, the Department of Education launched a programme, which aims at educating elementary school students about liver diseases.
In the past 27 years, the foundation has performed more than 700 free disease screenings, benefitting over 600,000 people—especially those in rural areas. It also has held over 1,000 liver disease awareness sessions for the general population and has set up a toll-free telephone line for patients or family members to discuss any liver disease-related issues. So far, there have been over 300,000 telephone consultations.
The contribution of the foundation in eradicating liver diseases has been recognised by the government of Taiwan, as well as agencies worldwide.
“More can be done. Collaborations with other organisations have allowed us to reach more people and increase awareness of liver diseases through joint efforts to provide education to the population. Mass-screening efforts mean that more patients are identified and treated early before the development of sequelae of chronic liver diseases,” states Prof Yang.
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1World Bank Data. Retrieved on: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=PK
2The Lancet Journal. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext#seccestile19