Seventy-eight per cent of people using needle and syringe
programmes in community pharmacies in London who opted to test for hepatitis C would prefer to receive their
hepatitis C treatment from the pharmacy, research in London has shown.
The findings come from the second phase of a pilot study
carried out by the London Joint Working Group on Substance Use and Hepatitis C,
which co-ordinates efforts to improve prevention, diagnosis and treatment of hepatitis C
in people who use drugs in the capital.
The first phase of the pilot investigated the acceptability
of rapid antibody testing for hepatitis C among people using community pharmacy
needle and syringe programmes, and the yield of testing – the proportion of
people who accepted an offer of a test and tested positive for hepatitis C virus (HCV) antibodies.
In the first phase, 216 people were tested in eight
pharmacies over four months and 53% were found to have hepatitis C antibodies.
Pharmacy-based oral antibody testing proved highly acceptable but there was a
high rate of loss to follow-up in people who tested positive, because of the
need to confirm chronic HCV infection by attending an outpatient clinic for
The second phase investigated whether using a point-of-care
test for HCV at the pharmacy instead of testing for hepatitis C
antibodies would improve linkage to hepatitis C care and treatment. The study
used the Cepheid capillary blood test.
In phase two of the study, 308 people were offered an HCV
antibody test at six participating pharmacies. Fifty-seven per cent accepted and
of these, approximately one-third (38%) tested positive for hepatitis C.
A high proportion of those who accepted a pharmacy test had
been tested for hepatitis C antibodies at least once before; 41% had been
tested in the previous year. Sixty-three per cent of those who tested positive in phase 2 were
already aware of their HCV infection.
Sixty of the 66 people who tested positive for HCV RNA were
referred for secondary care, of whom 21 attended appointments and 18 started
treatment. Fourteen completed treatment, four discontinued treatment, four were
cured, eight were awaiting final viral load results and two were lost to
Comparison of phase 1 and phase 2 showed no significant
difference in attendance at secondary care or treatment completion according to
Pharmacy testing proved highly acceptable to people who
agreed to an offer of a test; the average score for testing experience was 9.3
out of 10 and three-quarters said they would recommend the service to a friend.
The researchers are unable to explain the low attendance at
secondary care appointments by people diagnosed with chronic HCV infection.
They note that some pharmacies reported a lack of notification that people
diagnosed at the pharmacy had attended a secondary care appointment, and that
pharmacies that have developed a relationship with service users might be well
placed to encourage clinic attendance – if they are kept informed about
engagement with care.
However, the study also found that service users would
prefer to receive treatment at the pharmacy. Seventy-eight percent of those who
agreed to test would prefer to receive hepatitis C treatment at their community
pharmacy and 9% would prefer to receive treatment from a general practitioner.
The remaining 13% opted for either hospital treatment or accessing treatment
through a drug treatment service.
NHS England announced in July 2019 that it will invest £4
million over the next two years to support hepatitis C testing in pharmacies. The
researchers recommend that the Department of Health should change the law to
allow the prescribing and dispensing of direct-acting antivirals in community
Almost 30% of people who tested were unaware of new
interferon-free oral treatment for hepatitis C. The researchers recommend that
an information campaign targeting people who inject drugs should convey the
message that highly effective oral interferon-free treatment for hepatitis C is
now available, to improve uptake of testing.