Barriers to scaling up hepatitis C treatment in Malaysia: a qualitative study with key stakeholders

Abstract

Background While the availability of generic direct-acting antivirals (DAAs) opens the door for large-scale treatment, the care for people living with hepatitis C virus (HCV) in Malaysia is shifting toward a tripartite partnership between the public health system, correctional settings and civil society organizations (CSOs). This study aimed to explore the barriers to scaling up HCV treatment in Malaysia from the perspective of key stakeholders. Methods Eighteen focus-group discussions (FGDs) were conducted with 180 individuals, who actively engaged in coordinating, executing or supporting the implementation of the national strategic plan for HCV. An analytical framework was adapted to guide the data collection and thematic analysis. It covered four key aspects of HCV treatment: geographical accessibility, availability, affordability and acceptability. Results Movement restrictions in times of coronavirus disease 2019 (COVID-19) outbreaks and being marginalized translated into barriers to treatment access in people living with HCV. Barriers to treatment initiation in health and correctional settings included limited staffing and capacity; disruption in material supply; silos mentality and unintegrated systems; logistical challenges for laboratory tests; and insufficient knowledge of care providers. Although no-cost health services were in place, concerns over transportation costs and productivity loss also continued to suppress the treatment uptake. Limited disease awareness, along with the disease-related stigma, further lowered the treatment acceptability. Conclusions This study disclosed a series of supply- and demand-side barriers to expanding the treatment coverage among people living with HCV in Malaysia. The findings call for strengthening inter-organizational collaborations to overcome the barriers.

Budget impact analysis of two treatment approaches for hepatitis C in Malaysia through the use of voluntary and compulsory licensing options

“…However, there are still some patients who refuse to come to the hospital for fear of being infected with COVID-19 on top of their current hepatitis C illness. Also, several patients preferred to stay at home and delayed or defaulted their treatment to prevent themselves to meet people on their way to the hospital (33). Therefore, the findings in this study reflected the scenario before the COVID-19 pandemic.…”

“…Due to the COVID-19 pandemic, the hepatitis C treatment scenario in Malaysia was halted and the estimated number of patients treated from 2021 to 2022 was significantly lower. Several factors were found to interfere with the treatment programme during the pandemic, including barriers to accessing treatment for people living with HCV due to the limited public health budget for treatment, which was exacerbated by the pandemic, limited staffing and infrastructure to initiate treatment, and disruptions in medical supplies and clinical care (33). This circumstance has further hampered the initiation of DAA treatment from 2021 to 2022.…”

Assessing feasibility of a modified same-day test-and-treat model for hepatitis C among rural people who inject drugs

“…In 2019, the decentralization of HCV care in Malaysia allowed for access to rapid anti-HCV testing and DAA-based treatment for key populations at risk of HCV in primary healthcare (PHC) centers operated by the Ministry of Health [ 19 ]. While hospitals continue to serve as referral centers for those with cirrhosis and offer laboratory support for HCV ribonucleic acid (RNA) testing, not all people who inject drugs (PWID) seek medical care despite the high incidence of HCV [ 20 , 21 ]. Currently, active case-finding for HCV in Malaysia focuses on individuals receiving opioid substitution therapy (OST) in PHC centers [ 21 , 22 ].…”

“…While hospitals continue to serve as referral centers for those with cirrhosis and offer laboratory support for HCV ribonucleic acid (RNA) testing, not all people who inject drugs (PWID) seek medical care despite the high incidence of HCV [ 20 , 21 ]. Currently, active case-finding for HCV in Malaysia focuses on individuals receiving opioid substitution therapy (OST) in PHC centers [ 21 , 22 ]. Furthermore, logistical barriers associated with specimen delivery and lengthy laboratory turnaround times in PHC centers, especially in remote locations, remain unaddressed [ 21 ].…”

Diagnostic performance of two non-invasive biomarkers used individually and in sequential combination for cirrhosis associated with hepatitis C virus infection

“…However, it is often challenging to diagnose cirrhosis among potential treatment recipients in PHC settings due to the lack of facilities for imaging and biopsy 3 , 8 . Referring them to hospitals just for cirrhosis status assessment often results in loss to follow-up attributable to the stigma, logistical barriers and unaffordable transportation costs 9 , 10 .…”