Background:
In Malaysia, direct acting antivirals (DAA) are available at no cost to treat Hepatitis C (HCV), yet treatment initiation is often delayed by individual and logistical barriers. Treatment initiation involves multiple steps during which individuals may disengage from care, particularly among people who use drugs (PWUD). In this study, we aim to implement and evaluate a rapid-start model of care to reduce time to treatment initiation.
Methods:
We conducted a quasi-experimental study in suburban districts of Malaysia. The intervention model integrated community outreach for case detection, on-site phlebotomy immediately following a positive HCV antibody test, streamlined delivery of laboratory results, telemedicine consultations, and flexible medication delivery options. Participants in the intervention group received this rapid-start model of care, while those in the control group received standard care involving multiple clinic visits.
Results:
Since April 2025, 30 individuals have been enrolled: intervention group (n = 23) and control group (n = 7). All participants were male, with a median age of 52 years. Within the intervention group, 13 participants (57%) tested positive for HCV RNA and were deemed eligible for treatment, while 3 participants (13%) were found to have cirrhosis and were excluded from the study. All eligible individuals in the intervention group initiated treatment, with a median time to treatment initiation of 6 days following same-day testing and confirmatory assessment. As of the current reporting period, none of the participants in the control group have started treatment.
Conclusion:
To our knowledge, this is the first study to implement community-based phlebotomy and telemedicine for HCV care in the country. Preliminary findings indicate that this approach is feasible, with a median time to treatment initiation of 6 days which exceeded our anticipated target of 7 days. These results support the potential of low-barrier, community-based models, particularly in resource-limited settings. |