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Ravidasvir: equitable access through an alternative drug development pathway

Cheong MWL, Piedagnel JM, Khor SK

Lancet Glob Health, 2021 Nov;9(11):e1496-e1497.
PMID: 34678186 DOI: 10.1016/S2214-109X(21)00357-0
Fulltext What China can learn from Malaysia to achieve the goal of "eliminate hepatitis C as a public health threat" by 2030 - a narrative review

Sun J, Cheng H, Hassan MRA, Chan HK, Piedagnel JM

Lancet Reg Health West Pac, 2021 Nov;16:100261.
PMID: 34590064 DOI: 10.1016/j.lanwpc.2021.100261

Background: To discuss a range of strategic options for China to improve the accessibility of direct antiviral agents (DAAs) as the treatment for hepatitis C. Methods: We adopted a narrative review approach for comprehensive comparisons and in-depth analyses of the country context, and barriers of increasing the DAA treatment rate of hepatitis C in Malaysia and China, and how the two countries have been navigating the hepatitis C agenda. Findings: Malaysia adopted a series of successful strategies to scale up the diagnosis of hepatitis C and DAA treatment, which have valuable implications for China. Interpretation: The potential game-changing strategies for China to adapt from Malaysian experiences range from the stepping-up of political commitment and leadership, enhanced market competition, simplified and decentralized treatment at the strengthened primary care level, integrated healthcare services, coordinated government initiatives, to multi-organizational participation and civil society's active role in raising public awareness, and training of non-specialist physicians. Embarking on scale-up of hepatitis C treatment marks another contribution of China to improve the health of not only the Chinese citizens but also mankind, which is an important component for building healthy Chinese and global communities. Funding: No funding supported this study.
Fulltext Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study

Markby J, Shilton S, Sem X, Chan HK, Md Said R, Siva S, et al.

BMJ Open, 2021 Dec 24;11(12):e055142.
PMID: 34952885 DOI: 10.1136/bmjopen-2021-055142

INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.
METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.
RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).
CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

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