On June 1, 2023, National Health Insurance Administration (NHIA) officially announced the start of NHI Chronic Infectious Disease Care Quality Program; the aim of this Program is to improve the healthcare quality for patients with chronic infectious diseases including tuberculosis (TB), latent tuberculosis infection (LTBI), and HIV infection. The implementation of the Program helps integrate public health resources and NHI medical resources to develop a patient-centered disease management and care model that improves the effectiveness of treatments while ensuring disease prevention and reducing the burden of medical expenses. The Program consists of three main aspects, which are LTBI Treatment Quality and Payment Project, Reinforced TB Prevention Project for Long-Term Care Institutions, and HIV Care Management Quality and Payment Project. The Program requires an investment of NT$200 million a year, which will be covered by the budget of 2023 NHI medical benefits for hospitals and Western medicine clinics.

TB is one of the major infectious diseases in Taiwan with an average of 1 diagnosis every 80 minutes. To achieve the goal of eliminating TB by 2035, LTBI treatment has become the key prevention strategy worldwide; the treatment reduces the possibility of latent infections progressing into active TB for the patient and mitigates the spread of TB infection within a family, an institution, or a community. At the moment, a patient is diagnosed with LTBI that requires treatment every 45 minutes in Taiwan. With the implementation of this Program, medical facilities are encouraged to provide active and timely treatments and cares to groups with high LTBI risk, including individuals having contacts with patients with TB, remote villages in the mountains, inmates in correctional institutions, patients with HIV infection, and residents in long-term care institutions and tested positive of LTBI. Medical facilities shall work with the public health system to ensure care, tracking, and management of the patients, and accompany the patients to complete treatments to prevent it from progressing into active TB.

According to the statistics in Taiwan, the incidence rate of TB in long-term care institutions is 3.7 times higher than that of regular individuals of the age of 65 years or above, and 14 times higher than that of the general public. Approximately 15% of the residents in long-term care institutions tested positive for LTBI. Therefore, this Program will arrange for the designated medical facilities to provide professional care for the residents and staff in long-term care institutions. These medical facilities shall provide enhanced symptom assessments and rapid molecular tests for TB in such institutions to ensure early diagnoses and prevent the spread of TB; LTBI tests shall be carried out to everyone and curative care shall be provided to all patients with positive results.

Currently, the number of survivors of HIV infection in Taiwan is 35,274. With the case management mechanism and care in designated HIV treatment facilities, a patient-centered medical care is provided to improve the patients' self-care abilities and ensure the control of viral load to improve the health and quality of life.

NHIA and Taiwan Centers for Disease Control cooperated to implement the NHI Chronic Infectious Disease Care Quality Program. We hope that with the joint effort from public health and medical systems, the quality of medical care for the patients will be improved, NHI medical expenses will be reduced and the goal of eliminating TB and HIV infections will be achieved.