IntroductionTo 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.MethodsThis 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.ResultsDuring 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).ConclusionsThis 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.

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Clinical examination and biochemical tests ruled out thyrotoxicosis. Colonoscopy showed mild to moderate pancolitis. Histopathological examination of the colonic mucosa confirmed Langerhans cell histiocytosis. INTRODUCTIONLangerhans cell histiocytosis (LCH) is a rare disorder of unknown cause. The granuloma-like pathologic lesion is crucially characterised by cells sharing many characteristics with normal cutaneous Langerhans cells and variably associated with collections of T-lymphocytes, macrophages, neutrophils and eosinophils [1] . These cells, now known as LCH cells, are CD1a and Langerin-positive. LCH encompasses a spectrum of disorders with diverse clinical presentations, ranging from single organ to multiple organ involvements, which includes bone, skin, lung, gut, liver, bone marrow and central nervous system. LCH can occur at any age, but the peak incidence is in children below two years old [1][2][3] . The LCH patients may present with gastrointestinal involvement, yet symptoms like diarrhoea and failure to thrive, are nonspecific. The reported incidence ranges from 2% to 13%, but the actual figure is unknown. Well-documented colon involvement is very rare, with fewer than 20 convincing published reports worldwide. In these instances, initial presenting symptoms included diarrhoea, sometimes with blood or mucus, malabsorption, failure to thrive and oedema ABSTRACTLangerhans cell histiocytosis is a rare histiocytic disorder, characterised by histiocyte infiltration of the body organ. Although this disease has been diagnosed in all age groups, it is most common in children from one to three years old. The LCH patients may vary in presentation depending upon the sites and extent of involvement. The disease is limited to one organ system in approximately 55% of patients while the remainder presents with multisystem disease. Gastrointestinal involvement of Langerhans cell histiocytosis is even rarer. The majority of gastrointestinal Langerhans cell histiocytosis are from paediatric cases. We present a case of a 69-year old female who had presented with chronic diarrhoea for a three month duration, associated with a significant weight loss.