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Background:
Hepatitis C virus (HCV) infection is a significant public health challenge in Malaysian prisons, where national management guidelines are difficult to implement using standard care models. This study describes a phased, CFIR-informed approach to systematically develop, implement, and adapt the HCV care cascade within diverse prison settings.
Methods:
A multi-phase implementation study was conducted in Kedah state (two prisons, June 2022–December 2023) and subsequently in Perlis state (one prison, implementation ongoing), Malaysia. Following thematic analysis of multi-stakeholder meeting data to operationalise the national HCV guideline, the Consolidated Framework for Implementation Research (CFIR) was used. CFIR helped prospectively identify contextual determinants and guide the design of an adapted delivery strategy around the standard cascade, first in Kedah and subsequently for the distinct context of Perlis.
Results:
The initial CFIR analysis identified key barriers including low screening priority, logistical complexities of external referrals, staff shortages for escorts, and high inmate turnover. The resulting Kedah model, designed to overcome these challenges, featured opt-out screening and streamlined on-site management. It achieved 100% screening uptake across 18,811 admissions, identifying 655 individuals with active HCV infection. Of these, 319 (49.2%) initiated treatment, and the cure rate (SVR12) was 96.3% (77/80 tested). For Perlis, a subsequent CFIR-informed contextual analysis identified distinct barriers (e.g., smaller medical teams, laboratory logistics), leading to tailored adaptations such as periodic mass screening and inter-state laboratory collaboration. Implementation here is ongoing.
Conclusion:
Proactively applying CFIR was instrumental in bridging the gap from guideline to ground, facilitating an effective HCV care model in Kedah prisons and guiding necessary adaptations for Perlis. This study underscores the critical role of implementation science frameworks in tailoring interventions to local realities to improve health outcomes within resource-constrained settings.
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