Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study
Jagpreet Chhatwal,
Shahnaz Murad,
Suresh Kumar,
Fatanah Ismail,
Philippa Easterbrook,
Rozainanee Mohd Zain,
Jessica Markby,
Sonjelle Shilton,
Xiaohui Sem,
Huan Keat Chan,
Rosaida Md Said,
Sasikala Siva,
Zalwani Zainuddin,
Norasiah Abu Bakar,
Haniza Omar,
Ryan Jose III Ruiz,
Mary Gaeddert,
Alexander Tyshkovskiy,
Madeline Adee,
Jean-Michel Piedagnel,
Caroline Menétrey,
Fazidah Yuswan,
Nazrila Hairizan Nasir,
Isabelle Andrieux-Meyer,
Rozita Zakaria,
Ruziaton Hasim,
Muhammad Radzi Abu Hassan
Affiliations
Jagpreet Chhatwal
Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Shahnaz Murad
Drugs for Neglected Diseases initiative, Geneva, Switzerland
Suresh Kumar
Hospital Sungai Buloh, Sungai Buloh, Malaysia
Fatanah Ismail
Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
Philippa Easterbrook
World Health Organization, Geneva, Switzerland
Rozainanee Mohd Zain
Institute for Medical Research, Kuala Lumpur, Malaysia
Jessica Markby
4 FIND, Geneva, Switzerland
Sonjelle Shilton
FIND, Geneva, Switzerland
Xiaohui Sem
FIND, Geneva, Switzerland
Huan Keat Chan
Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
Rosaida Md Said
Hospital Ampang, Ampang Jaya, Malaysia
Sasikala Siva
Drugs for Neglected Diseases initiative, Geneva, Switzerland
Zalwani Zainuddin
Hospital Sultanah Bahiyah, Alor Setar, Malaysia
Norasiah Abu Bakar
Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
Haniza Omar
Hospital Selayang, Batu Caves, Malaysia
Ryan Jose III Ruiz
FIND, Geneva, Switzerland
Mary Gaeddert
Division of Clinical Tropical Medicine, Center of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
Alexander Tyshkovskiy
Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Madeline Adee
Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Jean-Michel Piedagnel
Drugs for Neglected Diseases initiative, Geneva, Switzerland
Caroline Menétrey
Drugs for Neglected Diseases initiative, Geneva, Switzerland
Fazidah Yuswan
Disease Control Division, Ministry of Health, Putrajaya, Malaysia
Nazrila Hairizan Nasir
Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
Isabelle Andrieux-Meyer
Drugs for Neglected Diseases initiative, Geneva, Switzerland
Rozita Zakaria
Klinik Kesihatan Putrajaya Presint 18, Ministry of Health Malaysia, Putrajaya, Malaysia
Ruziaton Hasim
Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
Muhammad Radzi Abu Hassan
Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
Introduction To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.Methods This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.Results During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).Conclusions This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.
