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Clinical Trial
. 2022 May 3;12(5):e059639.
doi: 10.1136/bmjopen-2021-059639.

Feasibility of decentralised, task-shifted hepatitis C testing and treatment services in urban Myanmar: implications for scale-up

Bridget Louise Draper  1   2 , Win Lei Yee  3 , Sonjelle Shilton  4 , Anna Bowring  5 , Hla Htay  3 , Nwe Nwe  4 , Jessica Markby  4 , Khin Pyone Kyi  6 , Philippa Easterbrook  7 , Win Naing  6   8 , Thin Mar Win  3 , Khin Sanda Aung  9 , Jessica Howell  5   10   11 , Alisa Pedrana  5   2   12 , Margaret Hellard  5   2   13   14   15
Affiliations
Clinical Trial

Feasibility of decentralised, task-shifted hepatitis C testing and treatment services in urban Myanmar: implications for scale-up

Bridget Louise Draper et al. BMJ Open. .

Abstract

Objectives: To assess the feasibility considerations for a decentralised, one-stop-shop model of care implemented in Yangon, Myanmar.

Setting: Two primary care level clinics in urban Yangon, Myanmar.

Design: This is a feasibility study of a highly effective care model. Using Intervention Complexity Framework by Gericke et al, we collated and analysed programmatic data and evaluation data to outline key project implementation requirements and experiences.

Participants: Programmatic data were collected from clinical records, GeneXpert device test and maintenance reports, national guidelines, product and device instructions and site monitoring visit reports. Healthcare providers involved in delivering care model contributed interview data.

Results: The main feasibility considerations are appropriate storage for test kits and treatments (in response to temperature and humidity requirements), installation of a continuous stable electricity supply for the GeneXpert device, air-conditioning for the laboratory room hosting GeneXpert, access to a laboratory for pretreatment assessments and clear referral pathways for specialist consultation when required. Lessons from our project implementation experiences included the extensive time requirements for patient education, the importance of regular error monitoring and stock storage reviews and that flexible appointment scheduling and robust reminder system likely contributed to high retention in care.

Conclusions: Detailed documentation and dissemination of feasibility requirements and implementation considerations is vital to assist others to successfully implement a similar model of care elsewhere. We provide 10 recommendations for successful implementation.

Trial registration number: The trial was registered at ClinicalTrials.gov NCT03939013 on May 6, 2019. This manuscript presents post-results data on feasibility.

Keywords: gastroenterology; health services administration & management; international health services; public health.

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Conflict of interest statement

Competing interests: MH has received investigator-initiated grant funding from Gilead Sciences and AbbVie for unrelated work. AP has received investigator-initiated grant funding from Gilead Sciences, MSD and AbbVie and speaker fees from Gilead Sciences for unrelated work. JH has received investigator-initiated grant funding and speaker fees from Gilead Sciences for unrelated work. WLY has received Gilead Sciences Fellowship for related work. KPK has received non-financial support from Mylan, Hetero and Royal Ruby. WN has received non-financial support from Mylan and Cipla. All others declare no potential competing interests.

Figures

Figure 1
Figure 1
CT2 feasibility—workflow and data collection. APRI, aspartate/platelet ratio index; DAA, direct-acting antiviral; GP, general practitioner; HBV, hepatitis B virus; HCV, hepatitis C virus; LFT, liver function test; RDT, rapid diagnostic test; SVR, sustained virological response; VL, viral load.
Figure 2
Figure 2
Key recommendations (recommendations 1–6). GP, general practitioner; HCV, hepatitis C virus; LMICs, low-income and middle-income countries; PoC, point-of-care; VL, viral load.
Figure 3
Figure 3
Key recommendations (recommendations 7–10). DAA, direct-acting antiviral; GP, general practitioner; HCV, hepatitis C virus.
See this image and copyright information in PMC

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