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.

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.