People who use drugs would prefer to get hepatitis C treatment at a community pharmacy

Keith Alcorn
Published:
04 October 2019

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 further tests.

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 follow-up.

Comparison of phase 1 and phase 2 showed no significant difference in attendance at secondary care or treatment completion according to testing method.

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 per cent 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 pharmacies.

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.

Reference

London Joint Working Group on Substance Use and Hepatitis C. HCV testing in NSP (needle and syringe provision) community pharmacies pilot (phase 2). September 2019.

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