Testing for hepatitis C at community pharmacies improves uptake of testing and treatment

Keith Alcorn
Published:
18 August 2022
Karolina Grabowska/Pexels

Reaching people who receive methadone opioid agonist therapy with the offer of an on-site hepatitis C test through their dispensing pharmacy greatly improved the uptake of hepatitis C testing and treatment when compared with standard procedures for hepatitis C screening, an international study has reported.

The study, carried out in Scotland, Wales and Australia, found that people offered point-of-care hepatitis C RNA testing at a pharmacy were 18 times more likely to be tested for hepatitis C compared to people who were directed to conventional testing venues by the pharmacist.

People with a history of injecting drug use are a priority group for hepatitis C screening as they have a high prevalence of chronic hepatitis C infection. But reaching this population with the offer of hepatitis C testing can be difficult as they may not be engaged with conventional health services.

Offering hepatitis C testing through drugs services or pharmacies that dispense methadone may be an acceptable alternative but not all pharmacies have the resources to carry out point-of-care testing.

The pharmacy study was designed to test whether attaching a nurse trained in point-of-care hepatitis C testing and discussion of testing to a cluster of pharmacies resulted in a higher rate of hepatitis C testing and treatment uptake and completion than pharmacist referral for testing.

The study recruited 1410 participants receiving methadone at 40 pharmacies in 20 study sites. Pharmacies were randomly assigned to the testing intervention or to standard of care. Nurses attended intervention pharmacies regularly for a week and carried out screening, providing results at a subsequent visit in most cases.

People diagnosed with chronic hepatitis C underwent confirmatory laboratory testing and could then initiate treatment with glecaprevir/pibrentasvir (Maviret), under the supervision of a nurse prescriber (United Kingdom) or a physician (Australia). Follow-up testing 12 weeks after completion of treatment was carried out at the pharmacy by nurses.

At standard-of-care pharmacies, pharmacists discussed hepatitis C testing if the opportunity arose and referred participants to community outreach clinics (UK) or their general practitioner (Australia) for testing. Direct-acting antiviral treatment was offered according to standard protocols to people who tested positive at these services.

The study population was predominantly male with a median age of 40 years.

The primary study outcome was the proportion of participants in each study arm who achieved a sustained virologic response.

Ten per cent (62 participants) in the standard-of-care arm agreed to test for hepatitis C, 17 actually underwent testing, six were positive and five started treatment.

In the intervention arm, 19% (148) agreed to test for hepatitis C, 97% (144) were tested, 23 were positive and 22 started treatment.

Two people in the standard-of-care arm (40% of those treated) and 18 in the intervention arm (82% of those treated) achieved a sustained virologic response.

Participants in the intervention arm were almost 17 times more likely to test for hepatitis C, four times more likely to start treatment, four times more likely to complete treatment and eight times more likely to be cured of hepatitis C, a multivariable analysis showed.

Dr Christopher Byrne, from the School of Medicine at the University of Dundee, said: “Our study is the first to implement nurse-led point-of-care testing – with results available on the same day – and treatment for hepatitis C in community pharmacies. Implementing models of care which bring hepatitis c testing and treatment into venues frequently used by people who use drugs can help to reduce the barriers to healthcare engagement, which is illustrated by the results of the trial. 

“The novelty of this research is that it provides evidence that engaging at-risk individuals and curing them of their infection is feasible and safe in community pharmacies, with little need for extra hospital visits, and that community pharmacists can play an important role in hepatitis C care.” 

Reference

Byrne CJ et al. Reaching people receiving opioid agonist therapy at community pharmacies with hepatitis C virus: an international randomised controlled trial. Alimentary Pharamacology & Therapeutics, 55: 1512-1523, 2022.