ArticleThe International journal on drug policy2025
Pre-implementation findings on the barriers and potential solutions to initiate same-day antiretroviral therapy among people who inject drugs in Malaysia.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Exploring multi-level barriers and human-centered solutions to expand methadone for HIV prevention among people who inject drugs in Kyrgyzstan.Journal of substance use and addiction treatment · 2026Article
- Barriers and facilitators to pre-exposure prophylaxis uptake among high-risk women and men who have sex with men in Georgia: A pre-implementation mixed-methods study using nominal group technique and the COM-B model.PLOS global public health · 2026Article
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11 authors.
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Abstract
backgroundRapid-start antiretroviral therapy (RS-ART), including same-day ART (SD-ART), effectively improves individual and public health by speeding up treatment initiation but is underutilized among people who inject drugs (PWID). As a pre-implementation activity, we assessed barriers and facilitators to SD-ART for PWID in Malaysia using insights from multiple stakeholders.
methodsWe conducted focus groups (n = 4) using nominal group technique (NGT), a mixed-methods research strategy, with PWID, HIV specialists, and community health workers (CHWs) in Greater Kuala Lumpur, Malaysia. This method involved open questions, round-robin listing of ideas, and participant voting to derive a rank-ordered consensus on major implementation barriers and facilitators, organized according to the socioecological model.
resultsAmong PWID (n = 5: 15 votes), the highest-ranking barriers included fear of police (40 %), procedural complexity (30 %), and discomfort with HIV providers (27 %). HIV specialists (n = 12: 36 votes) ranked readiness for treatment (27 %), risk of opportunistic infections (20 %), and incarceration concerns (13 %) as key barriers. CHWs (n = 7: 21 votes) pointed to complex appointment systems (33 %), delays in confirmatory testing (19 %), and stigma-reinforcing interactions with clinicians (19 %) as obstacles. Facilitators for PWID included initiating ART before reviewing results (27 %) and same-day counseling (27 %). For HIV specialists, essential strategies were enhancing NGO partnerships (33 %) and expanding ART options like dolutegravir (20 %). CHWs recommended simplifying treatment processes (33 %) and creating a dedicated clinic for HIV services (29 %).
conclusionDespite available harm reduction and HIV treatment services, structural and interpersonal stigma significantly hinder SD-ART initiation among PWID in Malaysia. Addressing stigma through tailored ART initiation strategies is crucial for closing this implementation gap.
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