Wei Chern Ang

Assessing health-related quality of life (HRQOL) promotes understanding well-being of people living with HIV (PLHIV). This study aims to determine factors influencing HRQOL. The cross-sectional study used a self-administered questionnaire among PLHIV receiving treatment in HIV clinic of a state hospital in Perlis, Malaysia. Potential subjects were approached in the waiting areas during routine clinic visits. The Malay questionnaire consists of WHOQOL-HIV BREF, EQ-5D-5L and EQ-VAS. Multiple linear regressions (MLRs) were used to identify independent predictors of HRQOL, and Spearman's correlations assessed the relationships between instruments. There were 88 participants in this study (mean age 43.5±13.1 years; 63.6% male). All were on antiretroviral therapy with undetectable viral loads. The mean overall WHOQOL score was 74.9±13.1 (on a 0-100 scale), EQ-5D index 0.90±0.13, and EQ-VAS 88.5±13.2. Each one-year increase in age was associated with a 3.3-point (β≈+3.3) higher WHOQOL score and middle-range household income of MYR3171-3970 (≈USD757-948 as of 1 USD=4.188 MYR) was linked to higher WHOQOL(β≈+8.7). In contrast, part-time employment corresponded to a lower WHOQOL(β≈-7.4). Having tertiary education and high income >MYR4850 (≈USD1158) were associated with lower EQ-VAS (β≈-10.3 and -16.0, respectively). An HIV transmission mode other than sex and intravenous drug use predicted significantly lower scores across all three HRQOL indicators. WHOQOL had a moderate positive correlation with EQ-5D (r=0.421) and a weaker correlation with EQ-VAS (r=0.265). PLHIV in Perlis, Malaysia reported generally good HRQOL despite the COVID-19 pandemic. Higher age and moderate income were associated with better WHOQOL, whereas higher education and income paradoxically lowered self-rated health (EQ-VAS). Multi-dimensional assessment (WHOQOL, EQ-5D, EQ-VAS) revealed consistent trends and underscores the importance of holistic care for PLHIV in pandemic conditions.

Objectives: To examine the availability, prices, and affordability of essential medicines for children (EMc) in community pharmacies (CPs). Methods: A cross-sectional survey was conducted across all CPs in Perlis. The median price ratio (MPR) was a ratio of the median unit price to reference. Affordability was based on the lowest daily wages required. Key findings: The mean availability of generic medication (55.9%) and brand medication (31.4%) was low. For international reference price, chlorpheniramine tablets and salbutamol syrup had the highest MPR among generic medication and brand medication, respectively. Asthma was the most expensive treatment. Conclusions: Availability of EMc is low in CPs. They cost higher but are still affordable.

Lack of pharmacogenomics knowledge among healthcare professionals is the most significant cited barrier to implementing pharmacogenomics in clinical settings. Despite the growth in research initiatives and awareness of pharmacogenomics, healthcare professionals continue to report a lack of knowledge and confidence in practicing pharmacogenomics. This study aims to assess the current pharmacogenomics knowledge gaps and learning needs of healthcare professionals in Malaysia. A modified Delphi with a multidisciplinary expert panel was conducted, and a purposive sampling method was used with predefined selection criteria. Fourteen study sites in Malaysia were included. The cut‐off value to approach consensus was predefined as a threshold of 60% or higher, and a quantitative descriptive statistical analysis was performed. The study demonstrated that all experts rated the suggested educational content components as essential/important to be included in the educational intervention. Additionally, experts highlighted the significant barriers and gaps to adopting and practicing pharmacogenomics. To conclude, this multisite Delphi study enabled the development of a tailored, effective, evidence‐based, competency‐based educational intervention in pharmacogenomics for healthcare professionals in Malaysia. To keep up with the rapid evolution of the pharmacogenomics field, healthcare professionals should be equipped with the necessary competencies required to practice pharmacogenomics for better health outcomes. Future research is needed to determine the feasibility of the proposed educational intervention.

Objective: In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia. Methods: A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%. Results: First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective. Conclusion: Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.

Halal pharmaceuticals are paramount in healthcare settings catering to Muslim patients. The COVID- 19 pandemic ignited discussions on the Halal status of pharmaceuticals, especially vaccines. This study aims to explore the understanding and views of hospital outpatients regarding Halal pharmaceuticals. A qualitative study by in-depth interviews was undertaken among adult Muslim outpatients. Utilising a semi-structured interview guide in Malay, content reliability of the guide was ensured through expert reviews. Potential participants were approached in the outpatient pharmacy waiting area. All interviews were audio recorded and transcribed verbatim. These Malay transcripts were translated into English and subjected to thematic content analysis. Data saturation was achieved through interviewing ten outpatients. The findings indicated that patients were vigilant in checking labels to confirm the correctness of their medications. Yet, the terms 'Halal pharmaceuticals' and 'Shariah-compliant hospital' were unfamiliar to all and did not evoke curiosity. The respondents expressed trust in the government's commitment to dispense safe and Halalcertified drugs. The majority of the participants did not consider Halal status as a primary factor when selecting medications. Nevertheless given a choice, many voiced a preference for Halal-certified drugs, irrespective of their cost or efficacy. For life-threatening situations, participants were willing to accept non-Halal treatments. Despite non-familiarity, the general sentiment towards Halal pharmaceuticals remain positive. This study underscores the need for enhanced education and awareness regarding Halal pharmaceuticals for better align healthcare practices with the cultural and religious values of Muslim patients.

Objective: This report aims to compare the effectiveness between electroconvulsive therapy (ECT) and transcranial direct stimulation (tDCS) among patients with treatment-resistant depression (TRD) and the associated factors. Methods: This was a secondary data analysis of a randomized, controlled, open-label trial conducted from 1 July 2018, to 31 December 2018. The dataset of 90 patients included in the study was retrieved from Mendeley Data. Patients with TRD were randomized 1:1 into either receiving ECT or tDCS. A good treatment response was determined as an improvement from the Hamilton Depression (HAM-D) baseline score at a rate of more than or equal to 50% at the end of a 2-week intervention. A mixed-effect logistic regression was performed to explain the hierarchical data structure of predictors to successful treatment outcome. Results: The largest magnitude of change was consistently observed in the ECT treatment arm across both HAM-D score and the clinical global impression severity scale (CGI-S) scale (p < 0.001). Lower baseline HAM-D scores (OR: 0.72, 95% CI: 0.58, 0.92), lower baseline CGI-S scale (OR: 0.30, 95% CI: 0.17, 0.55), and ECT as the choice of treatment modality (OR: 14.0, 95% CI: 5.08, 38.58) independently predicted successful therapy among TRD patients, while modelling with multiple logistic regression determined that low socio-economic status (aOR: 20.01, 95% CI: 1.89, 211.47), ECT (aOR: 31.7, 95% CI: 6.32, 159.0) and a lower baseline CGI-S scale (aOR: 0.18, 95% CI: 0.06, 0.57) were significantly predictive of a positive treatment outcome among patients with TRD. Conclusions: ECT was more effective in alleviating depressive symptoms in TRD as compared to tDCS.

Background: Per oral methadone maintenance therapy [MMT] was introduced as part of harm reduction strategy to manage rising numbers of HIV infections caused by intravenous use of illicit drugs. Method: We aim to review published articles related to the side effects of long-term methadone therapy, focusing on hematological derangements in human studies published between 1 January 2000 till 31 January 2021. Results: Our search databases include Web of Science, Scopus, and Medline. Our search yielded 971 articles, of which 55 articles were related to the effects of MMT on various organ systems: cardiovascular [n=12], respiratory [n=1], endocrine [n=10], central nervous system [n=12], neurobehavioral [n=10], gastrointestinal [n=1], and bone [n=1]. There were eight articles specifically related to the hematological side effects of chronic methadone therapy that include [i] immune system hyperactivation, [ii] reduced circulating lymphocytes, and [iii] increased blood viscosity. Conclusion: In view of all foreseeable health risks seen with prolonged methadone therapy, pharmacological modulation is warranted to find a better substitute for managing patients with opioid dependence.

Objectives: Halal pharmaceuticals have expanded globally, which is one of the elements in Shariah compliance hospitals. With the emergence of COVID-19 vaccines, the ‘Halal’ status has become a debate causing some to reject it. The aim of this study was to explore the perception of halal pharmaceuticals among hospital outpatients. Methods: A qualitative study by in-depth interviews were conducted among adult Muslim outpatients collecting their medications. A Malay language semi-structured interview guide was prepared and underwent content trustworthiness by the State Mufti, a Malaysian pharmacy professor, two pharmacists with a special interest in Halal pharmaceuticals and two Islamic affairs officers in the Ministry of Health Malaysia. Subjects were recruited in the waiting area of the outpatient pharmacy, Hospital Tuanku Fauziah (HTF). Interview sessions were audio-recorded and transcribed verbatim. The transcripts were back-translated in English and analysed using thematic content analysis. Results: Ten outpatients were interviewed in which data saturation was reached. Overall, the patients were proactive in observing the label to ensure they received the correct medications. However, all patients were unfamiliar and not curious about the concepts of ‘halal pharmaceuticals’ and ‘Shariah-compliant hospital’. The patients also trusted that the government would provide only the safest and halal medicines. Most patients did not prioritise halal status while choosing their medicines. However, if options were available, most would choose halal medication regardless of its price and effectiveness. They still would consent to receive non-halal treatments for life-saving conditions. Conclusion: There was a good perception of halal pharmaceuticals among outpatients in HTF. There are many opportunities for patient education on this topic as the public is currently not familiar with the terms and halal concepts in medical settings. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S16

Background: Vaccination is an effective public health intervention in reducing morbidity and mortality of infectious diseases. Compared to other countries where community pharmacists (CPs) administer vaccines, CPs in Malaysia are not authorised. This study aimed to assess CPs' readiness and willingness to provide vaccination in Malaysia, identify potential barriers to and factors supporting the provision of this service. Methods: A cross-sectional study was conducted among Malaysian CPs from April to June 2021. A validated online questionnaire was distributed through social media, instant messaging, email, and pharmacy societies. Results: Of 492 CPs recruited throughout Malaysia, 439 (89.2%) expressed willingness to provide vaccination services to the public, 403 (81.9%) agreed with the accessibility of community pharmacies to the public, and 73.4% agreed that their role in vaccination could help to improve the overall vaccination coverage rate. The lack of pharmacist training in vaccination and concerns on maintaining patient safety were identified as barriers to CPs' implementation of vaccination services, with 52.8% and 47.8% of them agreeing, respectively. Training sessions and operational guidelines on providing vaccination services are required to overcome the barriers. Conclusion: CPs in Malaysia were ready and willing to provide vaccination services to the public. However, the implementation demands training workshops and re-evaluation of CPs in public vaccination programmes by Malaysian healthcare policymakers.