Theme: Epidemiology & Public Health Research Year: 2022
Background:
Although hepatitis C (HCV) care has been decentralized through primary healthcare (PHC) centers
across Malaysia, hard-to-reach people who inject drugs (PWID) in remote areas, coupled with lengthy
laboratory turnaround time, continue to suppress massive treatment scale-up. This project piloted a
new public health approach, aiming to accelerate HCV treatment initiation among PWID from
resource-limited remote areas.
Methods:
This was a longitudinal, observational study undertaken in four PHC centers in Terengganu State. PWID
who tested positive for HCV antibody (anti-HCV) by rapid screening, either before or at the point of
the study, were identified. Confirmatory diagnosis of HCV was performed using the point-of-care
nucleic acid amplification testing equipment (GeneXpert®), which was placed in each PHC center in
turn throughout 2021. The cirrhosis status of PWID was assessed using non-invasive biomarkers (APRI
and FIB-4). The proportion of HCV-infected PWID who received their treatment with direct-acting
antivirals within the following 28 days of testing, along with the sustained virologic response-12
(SVR12) rate, was measured.
Results:
Confirmatory testing was performed on 199 PWID, including all the 95 (47.7%) existing untreated antiHCV-positive patients in PHC centers and 105 (52.3%) anti-HCV-positive PWID newly identified
through collaborations with civil society organizations and nearby health settings. Active HCV infection
was detected in 156/199 (78.4%) of them, 15 (9.6%) of whom were found to have developed
compensated cirrhosis. Treatment was successfully initiated within 28 days in 94.9% (141/156) of HCVinfected PWID, nearly 70% (108/156) of whom received treatment on the day of testing. The collection
of SVR12 result will continue until late June 2022; however, the SVR12 rate recorded by 31 treatment
recipients up until March 2022 was 93.5%.
Conclusion:
Through sharing point-of-care testing equipment and inter-organizational partnership, this new public
health approach successfully accelerated treatment initiation in PWID from remote areas who would
otherwise be neglected.
Disclosure of Interest Statement: No conflict of interest.