Hepatitis Screening and Treatment Campaign in Malaysia-Validation of Low-cost Point of Care Screening Tests and Nucleic Acid Tests for Hepatitis B and C

Proportion of People Who Are Positive for HBsAg and Anti-HCV Antibody Among Participants in a Community Screening Campaign in Malaysia

Background: The epidemiology of Hepatitis B (HBV) and C (HCV) remains poorly documented in Malaysia. Available statistics are based on data from mostly small studies in special populations. Objectives: In this study, we provide estimates of the proportion of people who are positive for HBs Antigen (HBsAg) and anti-HCV antibody (Ab) among participants in a community screening campaign. Methods: A total of 10,914 subjects participated in the hepatitis screening campaign organized by Hepatitis Free Pahang in 2018 and 2019. A low-cost point-of-care test, which has previously been validated, was used to screen for HBsAg and anti-HCV Ab. All screened positive subjects were recalled to undergo confirmatory serologic tests (enzyme-linked immunosorbent assay) and nucleic acid tests (Real-time Polymerase Chain Reaction. Results: We estimated that 1.17% of adults aged 20 or older who participated in the screening campaign were positive for HBsAg+, and only 0.71 percent were positive for anti-HCV Ab+. Young adults below 30 years of age had a very low proportion of HBsAg+ (0.09%). Women had a lower proportion of HBsAg+ and HCV- Ab+, Chinese had the highest proportion of HBsAg+, while Malay had the highest proportion of anti-HCV Ab+. Conclusions: Among adult participants of screening in Malaysia, chronic HBV is still common, especially among older and Chinese people. Adults with positive anti-HCV Abs are much less common.

Awareness and treatment of chronic hepatitis B in Malaysia-findings from a community-based screening campaign

INTRODUCTION

In 2016 the World Health Organization (WHO) had adopted a global strategy to eliminate Hepatitis B (HBV) by 2030 through five core interventions. One of which is the "cascade of care", the continuum of services that persons with chronic Hepatitis B Virus (HBV) should receive as they progress from screening to diagnosis to treatment to chronic care. We determined the prevalence of the awareness and treatment of chronic HBV in Malaysia based on a large sample data from a screening campaign.

METHODS

A total of 10,436 subjects participated in the HBV screening campaign organized by the Hepatitis Free Pahang Malaysia (HFP). Between in 2018 and 2019, HFP organized a total of 109 health fairs in partnership with local non-governmental organizations (NGO) to conduct HBV screening mostly in small towns and villages largely in the state of Pahang. All screen-positive subjects were recalled to undergo laboratory-based HBsAg and HBV DNA tests. Patients with confirmed chronic HBV were referred to local health services, while continued being monitored by HFP.

RESULTS

We estimated 13.1% of Malaysian adults aged 20 or older with chronic HBV were aware of their HBV status, and of those only 0.7% had received prior anti-viral treatment, but among those with baseline HBV DNA level > 20,000 IU/ml, 15.6% were subsequently treated. Tenofovir disoproxil fumarate was the only medicine used on all treated patients.

CONCLUSION

Few Malaysian adults with HBV were aware of their infection and even less received anti-viral therapy. Concerted public health efforts are urgently needed to improve HBV screening and care cascade in order to meet WHO's targets for HBV elimination.

What China can learn from Malaysia to achieve the goal of "eliminate hepatitis C as a public health threat" by 2030 - a narrative review

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.