Abstract
Background: Restrictive orders and temporary programmatic or ad hoc changes within healthcare and other supportive systems that were implemented in response to the COVID-19 epidemic in Malaysia may have created hindrances to accessing healthcare and/or receiving other supportive services for people who use drugs (PWUDs).Design: A primarily qualitative study has been conducted to evaluate how service providers and recipients were adapting and coping during the initial periods of the COVID-19 response.Settings: The study engaged several healthcare and non-governmental organizations (NGOs) in the peninsular states of Penang, Kelantan, Selangor, and Melaka.Participants: Medical personnel of methadone maintenance treatment (MMT) programs (n = 2) and HIV clinics (n = 3), staff of NGO services (n = 4), and MMT patients (n = 9) were interviewed using a semi-structured format.Results: Interviewed participants reported significant organizational, programmatic, and treatment protocols related changes implemented within the healthcare and support services in addition to nationally imposed Movement Control Orders (MCOs). Changes aimed to reduce patient flow and concentration at the on-site services locations, including less frequent in-person visits, increased use of telemedicine resources, and greater reliance on telecommunication methods to maintain contacts with patients and clients; changes in medication dispensing protocols, including increased take-home doses and relaxed rules for obtaining them, or delivery of medications to patients' homes or locations near their homes were reported by the majority of study participants. No significant rates of COVID-19 infections among PWUDs, including among those with HIV have been reported at the study sites.Conclusions: Although the reported changes presented new challenges for both services providers and recipients and resulted in some degree of initial disruption, generally, all participants reported successful implementation and high levels of compliance with the newly introduced restrictions, regulations, and protocols, resulting in relatively low rates of treatment disruption or discontinuation at the study sites.
Highlights
In response to the coronavirus (COVID-19) threat, Malaysia imposed several phases of the Movement Control Order (MCO) nationwide, beginning on March 18, 2020 (1)
The study combined a qualitative component, consisting of interviews with key personnel, service providers, and substance use disorders (SUDs) patients receiving treatment in participating clinics, and a quantitative component based on data from pre-MCO and during MCO/Conditional Movement Control Order (CMCO)/Recovery Movement Control Order (RMCO) periods from the maintenance treatment (MMT) program at Sungai Buloh Hospital (SBH) in Selangor
Prior to the MCO, take-home doses of methadone were provided according to the national guidelines to patients who were considered to be in a stable recovery, as determined by negative urine toxicology tests conducted randomly, at least once a month
Summary
In response to the coronavirus (COVID-19) threat, Malaysia imposed several phases of the Movement Control Order (MCO) nationwide, beginning on March 18, 2020 (1). During the CMCO period, most business and services were allowed to open, but entertainment outlets including cinemas, theme parks, religious and education institutions were ordered to remain closed. As the cases continued to decrease, the Recovery Movement Control Order (RMCO) was established between June 11 and August 31, 2020 and only 971 cases were recorded during this period (3). During this phase, more businesses were allowed to re-open. Restrictive orders and temporary programmatic or ad hoc changes within healthcare and other supportive systems that were implemented in response to the COVID-19 epidemic in Malaysia may have created hindrances to accessing healthcare and/or receiving other supportive services for people who use drugs (PWUDs)
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