Comparison of outcomes of partially decentralised HCV care in primary healthcare sites for PWID and non-PWID populations in Malaysia: The head-start project

Author: XiaoHui Sem Jessica Markby Sasikala Siva Rozainanee Mohd Zain Caroline Menétrey Fazidah Yuswan Nazrila Hairizan Nasir Isabelle Andrieux-Meyer Philippa Easterbrook Sonjelle Shilton Muhammad Radzi Abu Hassan

Theme: Models of Care Year: 2021

Background: Malaysia is estimated to have a hepatitis C virus (HCV) prevalence of 2.5% in the general population and 67.1% in people who inject drugs (PWID). The Foundation for Innovative New Diagnostics collaborated with the Ministry of Health and the Drugs for Neglected Diseases initiative on a Unitaid-funded Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project to introduce decentralised HCV screening at the primary healthcare clinics (PHCs). Here, we describe findings from the study comparing PWID with non-PWID. Description of intervention: HCV rapid diagnostic tests (RDTs) were introduced at 25 PHCs where participants at risk of HCV infection were screened. Antibody-positive patients were subsequently referred to one of five tertiary hospitals for confirmatory testing. Subsequently, after completion of confirmatory testing and pre-treatment assessments, patients were referred to initiate treatment either at PHCs or hospitals. Effectiveness: A total of 15,299 participants were screened using HCV RDT, of whom 12.7% (1,944/15,299) were PWID. 75.3% (1464/1944) of PWID were antibody-positive compared to 4.2% (566/13,355) in the non-PWID population (p < 0.001). There was no significant difference in the uptake of HCV confirmatory RNA testing according to PWID status. However, slightly lower proportions of PWID were RNA-positive compared to non-PWID: 82.5% (877/1,063) and 87.1% (364/418) respectively (p = 0.04). Similar proportions of RNA-positive PWID completed pre-treatment assessments, initiated treatment, completed treatment, received sustained virological response (SVR) testing and achieved SVR compared to non-PWID. Conclusions and next steps: Introduction of HCV RDTs at PHC sites has yielded good case finding for high-risk populations including PWID and encouraging retention of antibody-positive PWID for confirmatory testing and follow-up. Further optimisation and scale-up will involve a fully decentralised care pathway at expanded PHC sites to improve retention in the care cascade and decrease the turnaround time for all populations. Disclosure of Interest Statement: This study is fully funded by Unitaid.

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