Implementing HLA-B*58:01 testing prior to allopurinol initiation in Malaysian primary care setting: A qualitative study from doctors’ and patients’ perspective

Ng, Wei Leik and Hussein, Norita and Ng, Chirk Jenn and Qureshi, Nadeem and Lee, Yew Kong and Kwan, Zhenli and Kee, Boon Pin and Then, Sue-Mian and Abdul Malik, Tun Firzara and Zaidan, Fatimah Zahrah Mohd and Azmi, Siti Umi Fairuz (2024) Implementing HLA-B*58:01 testing prior to allopurinol initiation in Malaysian primary care setting: A qualitative study from doctors’ and patients’ perspective. PLoS ONE, 19 (1 Janu). ISSN 1932-6203, DOI

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Introduction Allopurinol, the first-line treatment for chronic gout, is a common causative drug for severe cutaneous adverse reactions (SCAR). HLA-B*58:01 allele was strongly associated with allopurinol-induced SCAR in Asian countries such as Taiwan, Japan, Thailand and Malaysia. HLA-B*58:01 screening before allopurinol initiation is conditionally recommended in the Southeast-Asian population, but the uptake of this screening is slow in primary care settings, including Malaysia. This study aimed to explore the views and experiences of primary care doctors and patients with gout on implementing HLA-B*58:01 testing in Malaysia as part of a more extensive study exploring the feasibility of implementing it routinely. Methods This qualitative study used in-depth interviews and focus group discussions to obtain information from patients with gout under follow-up in primary care and doctors who cared for them. Patients and doctors shared their gout management experiences and views on implementing HLA-B*58:01 screening in primary care. Data were coded and analysed using thematic analysis. Results 18 patients and 18 doctors from three different healthcare settings (university hospital, public health clinics, private general practitioner clinics) participated. The acceptability to HLA-B*58:01 screening was good among the doctors and patients. We discovered inadequate disclosure of severe side effects of allopurinol by doctors due to concerns about medication refusal by patients, which could potentially be improved by introducing HLA-B*58:01 testing. Barriers to implementation included out-of-pocket costs for patients, the cost-effectiveness of this implementation, lack of established alternative treatment pathway besides allopurinol, counselling burden and concern about genetic data security. Our participants preferred targeted screening for high-risk populations instead of universal screening. Conclusion Implementing HLA-B*58:01 testing in primary care is potentially feasible if a cost-effective, targeted screening policy on high-risk groups can be developed. A clear treatment pathway for patients who test positive should be made available. Copyright: © 2024 Ng et al.

Item Type: Article
Funders: Universiti Malaya [Grant no. PV016-2020]
Uncontrolled Keywords: Allopurinol; Drug-related side effects and adverse reactions; Gout; HLA-B antigens; Humans; Primary health care; Thailand
Subjects: R Medicine
Divisions: Faculty of Medicine > Biomedical Science Department
Faculty of Medicine > Medicine Department
Faculty of Medicine > Primary Care Medicine Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 03 May 2024 08:32
Last Modified: 03 May 2024 08:32

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