A step-wise approach to a national hepatitis C screening strategy in Malaysia to meet the WHO 2030 targets: Proposed strategy, coverage, and costs

Research output: Contribution to journalArticle

Accepted/In press
  • Lindsey Hiebert
  • Robert Hecht
  • Shan Soe-Lin
  • Rosmawati Mohamed
  • Fatiha Shabaruddin
  • Syed Mukhtar Syed Mansor
  • Maznah Dahlui
  • Amirah Azzeri
  • Scott A. McDonald

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Original languageEnglish
JournalValue in Health Regional Issues
StateAccepted/In press - 3 Dec 2018

Abstract

Objective. In Malaysia, over 330,000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. To inform the launch of a HCV elimination program, we estimated the required coverage and costs of a national screening strategy.
Methods. We designed a HCV screening strategy based on a “step-wise” approach. This approach relied on targeting of people who inject drugs (PWID) in the early years, with delayed onset of wide-spread general population screening. Annual coverage requirements and associated costs were estimated to ensure WHO elimination treatment targets were met.
Findings. In total, 6.0 million individuals would have to be screened between 2018-2030. Targeting of PWID in the early years would limit annual screening coverage to less than 1 million individuals from 2018-2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million (USD 58 million). Proportional to coverage targets, 60% of program costs would fall from 2026-2030.
Discussion. This exercise was one of the first attempts to conduct a detailed analysis of the required screening coverage and costs of a national HCV elimination strategy. These findings suggest that the step-wise approach could delay the onset of general population screening more than five years after the program’s launch. This delay would allow additional time to mobilize investments required for a successful general population screening program and also minimize program costs. This strategy prototype could inform the design of effective screening strategies in other countries.