Using nominal group technique (NGT) to identify barriers and facilitators to implement rapid-start direct-acting antiviral (DAA) for people who use drugs living with hepatitis C in Malaysia

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-08-21 DOI:10.1016/j.drugpo.2025.104966

N. Adi Azahar , D. Devi , S. Rampal , A. Kamarulzaman , NA. Mohd Salleh

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引用次数: 0

Abstract

Introduction

The uptake of direct-acting antiviral (DAA) is suboptimal among people who use drugs (PWUD) living with hepatitis C virus (HCV). However, innovative methods such as Rapid-Start DAA (RS-DAA) can expedite treatment initiation. We sought to explore the perspectives of HCV service providers, policy experts and PWUD to guide the development of an RS-DAA strategy in Malaysia.

Methods

Three separate focus groups were conducted in Klang Valley, Malaysia, using the Nominal Group Technique with HCV service providers, policy experts, and PWUD. These sessions included open questions, silent idea generation and individual round-robin feedback. Discussions were guided by Høj’s framework on access to HCV care, and concluded with a structured voting process, through which participants generated a rank-ordered list of ideas to systematically inform the RS-DAA strategy.

Results

A total of 23 participants were recruited: HCV service providers (n = 10, working in primary and tertiary healthcare settings), policy experts (n = 5, from public health organizations), and PWUD (n = 8, with varied HCV treatment experiences). Service providers identified delays in receiving HCV RNA results as the top barrier. Policy experts emphasized limited testing capacity and concerns about outreach team’s capabilities. PWUD cited time constraints due to work and family responsibilities. Potential solutions included enabling remote registration of new clients, improved laboratory coordination, and enhanced community awareness on HCV.

Conclusion

Addressing logistical challenges, fostering collaboration, and optimizing processes are essential for RS-DAA. The next step will involve revising the proposed protocol based on stakeholder feedback and moving towards its implementation.

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使用名义小组技术（NGT）确定障碍和促进因素，以便在马来西亚对丙型肝炎感染者实施快速启动直接作用抗病毒药物（DAA）

在丙型肝炎病毒（HCV）感染者（PWUD）中，直接作用抗病毒药物（DAA）的摄取不是最佳的。然而，快速启动DAA （RS-DAA）等创新方法可以加快治疗的启动。我们试图探索HCV服务提供者、政策专家和PWUD的观点，以指导马来西亚RS-DAA战略的发展。方法在马来西亚巴生谷进行了三个独立的焦点小组，采用名义小组技术，由HCV服务提供者、政策专家和PWUD组成。这些会议包括开放式问题，无声的想法产生和个人循环反馈。讨论以Høj的HCV治疗可及性框架为指导，并以结构化投票程序结束，通过该程序，参与者生成了一份按顺序排列的想法清单，以便系统地为RS-DAA战略提供信息。结果共招募了23名参与者：HCV服务提供者（n = 10，在初级和三级卫生保健机构工作），政策专家（n = 5，来自公共卫生组织）和PWUD （n = 8，具有不同的HCV治疗经验）。服务提供者认为接收HCV RNA结果的延迟是最大的障碍。政策专家强调了有限的测试能力和对外联小组能力的担忧。PWUD表示，由于工作和家庭责任，时间有限。潜在的解决方案包括实现新客户的远程注册、改进实验室协调和提高社区对丙型肝炎病毒的认识。结论应对后勤挑战、促进协作和优化流程对RS-DAA至关重要。下一步将涉及根据利益相关者的反馈修改拟议的协议，并朝着实施的方向迈进。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.