• Estimating the Population Size of People Who Inject Drugs in Malaysia for 2014 and 2017 Using the Benchmark-Multiplier Method.

      Hiebert, Lindsey; Azzeri, Amirah; Dahlui, Maznah; Hecht, Robert; Mohamed, Rosmawati; Hana Shabaruddin, Fatiha; McDonald, Scott A (2020-01-01)
      Background: As hepatitis C elimination efforts are launched, national strategies for screening and treatment scale-up in countries, such as Malaysia, must be designed and implemented. Strategic information, including estimates of the total number of patients chronically-infected with hepatitis C virus (HCV) and the size of key populations, such as people who inject drugs (PWID), is critical to informing these efforts. For Malaysia, the estimate of the PWID population size most frequently reported in global systematic reviews is for the year 2009. Objectives: To support ongoing national HCV planning efforts, we aimed to estimate the national population size of active PWID in Malaysia, for the years 2014 and 2017. Methods: To estimate the PWID population size, we applied standard benchmark-multiplier methodology, frequently used for PWID population size estimation, and extended it by adjusting for cessation of injecting drug use within the benchmark and calculating statistical uncertainty intervals. Results: The estimated active PWID population size was 153,000 (95% uncertainty interval (UI): 136,000-172,000) for 2014 and 156,000 (95% UI: 137,000-188,000) for 2017. Conclusions/importance: This updated estimate of the active PWID population size in Malaysia will help inform effective planning for the scale-up of HCV screening and treatment services. The proposed methodology is applicable to other countries that maintain national HIV registries and have conducted Integrated Biological and Behavioral Surveys among active PWID.
    • Projections of the Healthcare Costs and Disease Burden due to Hepatitis C Infection under Different Treatment Policies in Malaysia, 2018-2040.

      McDonald, Scott A; Azzeri, Amirah; Shabaruddin, Fatiha Hana; Dahlui, Maznah; Tan, Soek S; Kamarulzaman, Adeeba; Mohamed, Rosmawati (2018-08-25)
      The World Health Organisation (WHO) has set ambitious goals to reduce the global disease burden associated with, and eventually eliminate, viral hepatitis.
    • A Stepwise Approach to a National Hepatitis C Screening Strategy in Malaysia to Meet the WHO 2030 Targets: Proposed Strategy, Coverage, and Costs.

      Hiebert, Lindsey; Hecht, Robert; Soe-Lin, Shan; Mohamed, Rosmawati; Shabaruddin, Fatiha H; Syed Mansor, Syed Mukhtar; Dahlui, Maznah; Azzeri, Amirah; McDonald, Scott A (2019-03-25)
      In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. We designed an HCV screening strategy based on a "stepwise" approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030.