KUALA LUMPUR, August 2 — The Malaysian AIDS Foundation (MAF), Malaysian AIDS Council (MAC), and Sunway Group presented a special satellite symposium at the 25th International AIDS Conference on July 25.
Prof Dr Adeeba Kamarulzaman, the chair of MAF, led the symposium, which highlighted Malaysia’s advancements in HIV prevention through pre-exposure prophylaxis (PrEP) and innovative financing models for HIV/AIDS programmes.
Dr Anita Suleiman, president of the College of Public Health Medicine and former director of the Disease Control Division at the Ministry of Health (MOH), is credited as the architect of Malaysia’s PrEP programme. Her presentation titled, “Harmonising Health and Belief: PrEP Journey in Malaysia”, explained PrEP’s alignment with Islamic principles and detailed the roadmap for integrating PrEP into primary health care by 2025.
Dr Anita highlighted several key Islamic ethical principles supporting PrEP:
- The preservation of life (hifz al-nafs) is paramount, and PrEP prevents HIV infection, aligning with this objective by protecting individuals from a life-threatening disease.
- The principle of preventing harm (darar) views PrEP as a tool to prevent the significant harm caused by HIV.
- Seeking medical treatment (tadawi) encompasses PrEP as a preventive measure, aligning with the broader scope of seeking treatment to prevent future illness.
- Ethical use of resources (adl) ensures that PrEP is accessible to those at high risk of HIV infection, promoting overall public health and justice in medical resource allocation.
Dr Anita said Islamic values emphasise informed consent and individual autonomy, and health care providers must ensure individuals are fully informed about PrEP. “Engaging religious and community leaders and using culturally sensitive communication are essential for promoting PrEP,” she said.
On the PrEP roadmap, Dr Anita explained that PrEP has been built into the National Strategic Plan for Ending AIDS 2016-2030 by the MOH. This plan was realised through a series of regional consultations, national surveys, price reductions in generic tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), and multisite PrEP demonstration projects.
By 2023, the National Pharmaceutical Regulatory Agency (NPRA) had approved new oral PrEP options and expanded PrEP services in government health clinics.
Dr Anita noted that Malaysia’s approach draws on proven strategies from countries like Australia, Brazil, Kenya, Zambia, and Thailand, which emphasise early adoption, government support, community involvement, targeted programmes, and robust monitoring and evaluation.
Dr Mazliza Ramly, principal assistant director of MOH’s Disease Control Division, complemented Dr Anita’s presentation by highlighting the “PrEPGov” project.
This project aims to overcome barriers to PrEP through community engagement and integration with primary health care. It includes forming a PrEP Navigator Network to assist users in managing their PrEP usage and sensitising health care providers to reduce stigma and discrimination against key populations.
Dr Mazliza highlighted the success of the PrEP programme in Malaysia, noting low HIV seroconversion rates and strong community collaboration. Preliminary results show high retention rates, positive behavioural changes, and increased HIV screening, indicating the programme’s effectiveness.
Dr Raja Iskandar Shah Raja Azwa, President of MAC and Associate Professor of Infectious Disease at Universiti Malaya, along with Yan Nee Gan, implementation science researcher from Universiti Malaya, presented research on alternative modalities for PrEP delivery.
Dr Raja Iskandar Shah’s presentation on JOM-PrEP highlighted the innovative use of mHealth technologies to make PrEP accessible beyond clinical settings in Malaysia.
Together with collaborators from University of Connecticut and Yale, the JOM-PrEP app, a new clinic-integrated app was adapted to the local Malaysian health context from a pre-existing HealthMindr app, to deliver holistic HIV prevention services.
It integrates comprehensive HIV prevention services, including HIV testing using HIV self-test kits, PrEP services (HIV risk assessment, lab appointments, e-consultation, PrEP delivery) a chat function, mental health, and substance use services.
Beta testing over 30 days showed high user engagement and app acceptability among 50 men in Greater Kuala Lumpur. Notably, 84 per cent of participants ordered an HIV self-testing kit through the app, and 92 per cent used it to start PrEP, with many opting for same-day initiation.
The app also facilitated mental health screenings, with 89 per cent of those screened for depression meeting criteria for moderate-to-severe symptoms and receiving referral letters for mental health support.
The next phase involves a randomised controlled trial to evaluate the app’s efficacy in improving HIV testing and PrEP uptake among the participants compared to the treatment as usual arm, using the constructs of Consolidated Framework for Implementation Research to explore implementation factors to guide adoption and scale up in real-world settings.
The study also addresses challenges to mHealth implementation in the broader context, such as privacy and data security, platform compatibility, and network access, emphasizing the need for high-quality research.
Overall, the JOM-PrEP app demonstrates potential in overcoming barriers to PrEP access and enhancing HIV prevention services in Malaysia through tailored mHealth solutions.
Meanwhile, Yan presented an implementation research study on a pharmacy-led PrEP service delivery model designed to increase PrEP access and uptake in the Klang Valley.
This model leverages the accessibility of community pharmacies and the expertise of highly trained community pharmacists, who are often the first point of contact for health advice.
It also incorporates HIV self-test kits available at pharmacies to support PrEP initiation and continuation, simplifying the delivery of PrEP services in a non-clinical setting.
Conducted at six private community pharmacies in the Klang Valley, the study gathered real-world implementation findings, including out-of-pocket expenses where participants paid for PrEP medication and recommended lab tests.
The pharmacists collaborated with physicians through a telemedicine platform to enable same-day PrEP via electronic prescription. The study’s preliminary findings indicated high acceptability and feasibility, with high initiation and retention rates among participants.
The study also noted high satisfaction among participants, many of whom were willing to recommend and continue using the service. Community pharmacies offer reliable information, testing, and medication counselling, along with proximity and convenience, making them well-suited to deliver HIV prevention services to the community.
There was significant interest in this model both regionally and internationally at the AIDS 2024 conference. The panel discussion explored the potential for scaling up the pharmacy-led PrEP service delivery model in Malaysia, marking a significant step toward making HIV prevention more accessible and supporting Malaysia’s goal of ending AIDS by 2030.
The panel discussion resulted in several recommendations to improve PrEP uptake and effectiveness. These included wider integration of PrEP into national HIV strategies, establishing a supportive legal framework, and increasing funding through government and international partnerships.
It emphasised the need to strengthen health care infrastructure, including mobile and community clinics, and to implement robust monitoring and evaluation systems.
It also stressed respecting cultural and religious norms, ensuring confidentiality, and providing comprehensive support to promote PrEP as a key tool in the fight against HIV. Collaborative efforts and sustained commitment will protect vulnerable populations and enhance public health outcomes.
The symposium also underscored the importance of sustaining HIV/AIDS programmes in the post-pandemic world. With shifting health care priorities and resources being redirected, robust financing strategies for HIV/AIDS programmes remain crucial.
A unique tripartite partnership between MAF, the Malaysian government, and Sunway Group was highlighted as one of the best examples of sustaining these efforts.
Sunway Group chief brand strategy officer Nik Tasha Nik Kamaruddin described Malaysia’s HIV funding scenario, which includes domestic public funding, domestic private funding, and international contributions.
The majority of funding comes from domestic public sources, with significant contributions from domestic private and international sources.
The National Strategic Plan for Ending AIDS 2016-2030 allocates 75 per cent of total funding to treatment, care, and support programmes, including first-line ARV, counselling services, support groups, and basic health care services.
However, data indicated that 45 per cent of people living with HIV (PLHIV) in Malaysia lack access to medication, highlighting the need for improved funding and resources.
Sunway Group addresses these gaps through initiatives like the Sunway HOPE Borneo Programme, which provides cash incentives to low-income patients with HIV and other chronic diseases to cover travel and logistics costs for hospital appointments.
This programme is offered to Malaysians living in Borneo with a monthly household income of RM2,000 and below. Sunway HOPE builds critical connections between rural patients and advanced health care services, addressing issues like poverty, challenging public infrastructure, and poor health and treatment literacy.
The programme has positively impacted over 600 beneficiaries, with Sunway committing RM5 million to the initiative.
Additionally, Sunway has integrated the Sunway Food Bank into the HOPE programme, providing food aid to around 800 beneficiaries.
The Teratak Kasih Tok Nan Sarawak initiative offers health care access, transportation, and cash assistance for logistical costs to underprivileged people in Sarawak with HIV and other chronic diseases. This initiative has enrolled 138 beneficiaries, with a significant portion being PLHIV.
Sunway’s efforts have created long-lasting positive impacts, including improved adherence to medical treatment among PLHIV, better provision of second-line ARV treatment, and enhanced food security in East Malaysia.
The United Nations Sustainable Development Goals (SDG) 2023 report emphasises the importance of ending AIDS by increasing investment through evidence-based HIV prevention and treatment, health system integration, and empowered community networks.
The strategic impact of corporate social responsibility (CSR) in this context underscores the importance of continued partnerships between the private sector, non-government organisations (NGOs), and the government to achieve the goal of ending AIDS in Malaysia.
CSR initiatives instil hope and empowerment in beneficiaries, motivating them to adhere to treatment and improve their quality of life.
Corporate funding addresses critical gaps in existing funding for HIV/AIDS treatment, ensuring that the goals of ending AIDS by 2030 can be realised.
The NGO-corporate-government partnership model exemplifies SDG 17: Partnership for the Goals, serving as a successful multi-sector collaboration that can be replicated across Asia and Southeast Asia.
