Abstract
BackgroundWhile 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.MethodsEighteen 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.ResultsMovement 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.ConclusionsThis 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.
Highlights
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)
The use of costly direct-acting antivirals (DAAs) for HCV treatment was once restricted by the limited public health budget [6]
In line with the World Health Organization (WHO)’s recommendation, Malaysia subsequently introduced a DAA-based regimen consisting of sofosbuvir and daclatasvir to be used as the standard hepatitis C treatment in public hospitals [8, 9]
Summary
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). The public healthcare system in Malaysia, under the lead of the Ministry of Health, has a long history of. The use of costly direct-acting antivirals (DAAs) for HCV treatment was once restricted by the limited public health budget [6]. In line with the WHO’s recommendation, Malaysia subsequently introduced a DAA-based regimen consisting of sofosbuvir and daclatasvir to be used as the standard hepatitis C treatment in public hospitals [8, 9]. To further scale up HCV screening and treatment, Malaysia launched a 5-year national strategic plan in 2019, which marked the transition of HCV care from a hospital-based model to a community-based model [10, 11]
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