1
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Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM. The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement. Public Health 2024; 232:153-160. [PMID: 38781782 DOI: 10.1016/j.puhe.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This aimed to develop a blueprint for an effective community pharmacy Hepatitis C virus (HCV) testing service by producing a consensus statement. STUDY DESIGN This was a modified Delphi process. METHODS We recruited a heterogenous panel of experts (who had been involved in the setup or delivery of a community pharmacy HCV testing service) by purposive and chain referral methods. We had three rounds of a modified Delphi process. The first was a series of questions with free text responses and was analysed using thematic analysis, and the second and third were statements for the respondents to rate using a 7-point Likert scale. Consensus was predefined in a published protocol, and the results were reviewed by a public and patient involvement panel before the statement was finalised. RESULTS We had 24 participants, including community and hospital-based pharmacists, local pharmaceutical committee members, charity representatives (Hepatitis C Trust), local clinical service lead, nurse specialists and doctors. The response rate of the first, second and third rounds were 100%, 96% and 88%, respectively. After the third round, we had 60 statements that reached consensus. We discussed the accepted statements with a patient and public involvement group. We used these statements to produce the I-COPTIC statement and a graphical summary. CONCLUSIONS We developed a blueprint for the design of a gold standard community pharmacy HCV testing service. We believe this will support the successful implementation of community pharmacy testing for HCV. Community pharmacy testing is an important service to help achieve and maintain HCV elimination.
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Affiliation(s)
- C Cook
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - L Reid
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - A M Elsharkawy
- Liver Unit and NIHR Biomedical Research Centre at University Hospitals Birmingham NHS Trust and University of Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - A Radley
- NHS Tayside/University of Dundee, Nethergate, Dundee, DD1 4HN, UK.
| | - S Smith
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - S McPherson
- Liver Unit and NIHR Biomedical Research Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - D Crockford
- Community Pharmacy South Central, Sentinel House, Harvest Crescent, Fleet, Hampshire, GU51 2UZ, UK.
| | - J F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - M Wright
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - D Morris
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - H Malik
- Carter's Chemist 114-116 Fowler Street, Southshields, NE33 1PZ, UK.
| | - S Keall
- Community Pharmacy Tees Valley, UK.
| | - J Powell
- Community Pharmacy Surrey and Sussex, PO Box 1061A, Surbiton, KT1 9HJ, UK.
| | - J Catt
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - H Hampton
- Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LJ, UK.
| | - H Boothman
- St George's NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - S Shah
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - J Spear
- University Hospital of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - A Ustianoski
- Manchester University Foundation Trust & University of Manchester UK, Regional Infectious Diseases Unit, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK.
| | - P John
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - H Stevens
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - S I Khakoo
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - J Parkes
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - R M Buchanan
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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2
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Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
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Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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3
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Conway A, Stevens A, Murray C, Prain B, Power C, McNulty A, Carrington N, Lu H, Kingsland M, McGrath C, Read P, Starr M, Catlett B, Cunningham P, Grebely J. Hepatitis C Treatment Uptake Following Dried Blood Spot Testing for Hepatitis C RNA in New South Wales, Australia: The NSW DBS Pilot Study. Open Forum Infect Dis 2023; 10:ofad517. [PMID: 38023551 PMCID: PMC10665037 DOI: 10.1093/ofid/ofad517] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Dried blood spot (DBS) testing for hepatitis C virus (HCV) RNA provides a sampling option that avoids venepuncture and can be carried out in a nonclinical setting. Large-scale evaluations are needed to understand how DBS testing can reduce HCV burden. This study estimated prevalence of, and factors associated with, HCV RNA and treatment initiation among people enrolled in a state-wide pilot of people testing in the NSW DBS Pilot in New South Wales, Australia. Methods People at risk of HIV/HCV could participate via (1) self-registration online with a DBS collection kit delivered and returned by conventional postal service; or (2) assisted DBS sample collection at a community site or prison. Logistic regression was used to identify factors associated with detectable HCV RNA and treatment initiation within 6 months of testing. Results Between September 2017 and December 2020, 5960 people were tested for HCV (76% men, 35% Aboriginal and/or Torres Strait Islander, 55% recently injected drugs): 21% online self-registration, 34% assisted registration in the community, 45% assisted registration in prison. Fifteen percent had detectable HCV RNA (878/5960). Overall, 44% (n = 386/878) of people with current HCV initiated treatment within 6 months (13% online self-registration, 27% assisted registration in the community, 61% assisted registration in prison). Testing in prison compared with the community (adjusted odds ratio [aOR], 4.28; 95% CI, 3.04-6.03) was associated with increased odds of treatment initiation. Being a woman compared with a man (aOR, 0.68; 95% CI, 0.47-0.97) was associated with reduced treatment initiation. Conclusions The NSW DBS Pilot demonstrates the feasibility of using DBS to promote HCV testing and treatment in community and prison settings.
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Affiliation(s)
- Anna Conway
- The Kirby Institute, UNSW, Sydney, Australia
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Annabelle Stevens
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - Carolyn Murray
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - Bianca Prain
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - Cherie Power
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | | | - Nigel Carrington
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | - Heng Lu
- Sydney Sexual Health Centre, Sydney, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Population Health Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Colette McGrath
- NSW Justice Health & Forensic Mental Health Network, Sydney, Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - Mitchell Starr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia
| | - Beth Catlett
- The Kirby Institute, UNSW, Sydney, Australia
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia
| | - Philip Cunningham
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia
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4
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Stämpfli D, Imfeld-Isenegger TL, Hersberger KE, Messerli M. Hepatitis C virus screening in community pharmacies: results on feasibility from a Swiss pilot. BMC Infect Dis 2023; 23:384. [PMID: 37286975 DOI: 10.1186/s12879-023-08362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infections are a public health burden worldwide and often go undetected until sequelae develop. Offering HCV screening for the different vulnerable populations in community pharmacies could help prevent further undetected HCV infections. This pilot aimed to assess the feasibility and pharmacist acceptance of HCV rapid antibody saliva testing in community pharmacies. METHODS A structured pharmaceutical care intervention was developed that included addressing, informing, and screening clients, as well as referral and reporting to subsequent health care providers. Participating pharmacies from French-, German- and Italian-speaking parts of Switzerland were trained to provide this service to local vulnerable populations. Information on client recruitment, feasibility, and acceptability of HCV screening was collected. RESULTS Of 36 pharmacies initially recruited, 25 started the pilot and approached 435 clients, 145 of whom (33%) were interested in screening. Eight of these rapid antibody tests returned positive (prevalence rate: 5.5%). Facilitators were being able to offer a free rapid test (73%), followed by having training prior to the project (67%) and having a new service to offer (67%). The possibility of clients reacting dismissively (53%) and of unsettling clients (47%) were reported to be the main barriers. CONCLUSIONS This pilot demonstrated the general feasibility of an HCV screening service with rapid antibody saliva testing in Swiss community pharmacies, which achieved a higher prevalence rate than national estimates. With appropriate communication training and remuneration, Swiss community pharmacies could be an important partner in implementing HCV elimination strategies.
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Affiliation(s)
- Dominik Stämpfli
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, ETH Zurich, Vladimir-Prelog-Weg 4, CH-8093, Zurich, Switzerland.
- Hospital Pharmacy, Kantonsspital Baden, Switzerland.
- Pharmaceutical Care Network Switzerland, Basel, Switzerland.
| | - Tamara Leila Imfeld-Isenegger
- Hospital Pharmacy, Luzerner Kantonsspital, Luzern, Switzerland
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Network Switzerland, Basel, Switzerland
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Markus Messerli
- Pharmaceutical Care Network Switzerland, Basel, Switzerland
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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5
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Robinson E, Byrne CJ, Carberry J, Radley A, Beer LJ, Inglis SK, Tait J, Macpherson I, Goldberg D, Hutchinson SJ, Hickman M, Dillon JF. Laying the foundations for hepatitis C elimination: evaluating the development and contribution of community care pathways to diagnostic efforts. BMC Public Health 2023; 23:54. [PMID: 36611156 PMCID: PMC9826577 DOI: 10.1186/s12889-022-14911-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C Virus (HCV) is a public health threat which contributes substantially to the global burden of liver disease. There is much debate about effective approaches to scaling up diagnosis of HCV among risk groups. Tayside, a region in the East of Scotland, developed low-threshold community pathways for HCV to lay the foundations of an elimination strategy. In this retrospective study, we sought to: quantify the contribution of community pathways to increasing HCV diagnosis; understand if shifting diagnosis to community settings led to a higher proportion of individuals tested for HCV being actively infected; and describe functional characteristics of the care pathways. METHODS Descriptive statistics were used to for analysis of routinely-collected HCV testing data from 1999 to 2017, and a review of the development of the care pathways was undertaken. Community-based testing was offered through general practices (GP); nurse outreach clinics; prisons; drug treatment services; needle and syringe provision (NSP) sites; community pharmacies; and mosques. RESULTS Anti-HCV screening was undertaken on 109,430 samples, of which 5176 (4.7%) were reactive. Of all samples, 77,885 (71.2%) were taken in secondary care; 25,044 (22.9%) in GPs; 2970 (2.7%) in prisons; 2415 (2.2%) in drug services; 753 (0.7%) in NSPs; 193 (0.2%) pharmacies; and 170 (0.1%) in mosques. The highest prevalence of HCV infection among those tested was in NSP sites (26%), prisons (14%), and drug treatment centres (12%). CONCLUSIONS Decentralised care pathways, particularly in harm reduction and other drug service settings, were key to increasing diagnosis of HCV in the region, but primary and secondary care remain central to elimination efforts.
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Affiliation(s)
- Emma Robinson
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. .,Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK. .,Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - James Carberry
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.,Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Lewis J Beer
- Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Jan Tait
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Iain Macpherson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - David Goldberg
- Public Health Scotland, Meridian Court, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon J Hutchinson
- Public Health Scotland, Meridian Court, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John F Dillon
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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6
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Cook C, Reid L, Smith S, Crockford D, El Sharkawy AM, McPherson S, Wright M, Radley A, Malik H, Keall S, Catt J, Shah S, Hampton H, Powell J, Morris D, Boothman H, Khakoo SI, Parkes J, Buchanan RM. I-COPTIC: Implementation of community pharmacy-based testing for hepatitis C: Delphi consensus protocol. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:541-547. [PMID: 35997159 DOI: 10.1093/ijpp/riac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/22/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The World Health Organisation aims to eliminate Hepatitis C (HCV) by 2030. To achieve this, targeted testing needs to be widely available. Studies have demonstrated that community pharmacies can deliver effective targeted testing for HCV and the National Health Service in England has commissioned a national service. However, a recent survey of HCV operational delivery networks has shown limited uptake of this service. The objective of this protocol is to guide the formation of a consensus statement to facilitate the widespread implementation of community pharmacy-based targeted testing for HCV. METHOD We will use a modified Delphi method. A purposive selection of panel participants will be identified and recruited from a national survey and via chain-referral sampling. The main inclusion criteria for selection is direct involvement in the implementation of an HCV testing service in pharmacies. We aim for a heterogenous group, encompassing all aspects of the testing service. We will conduct a three round Delphi. The first round will consist of open questions which will be qualitatively analysed using thematic analysis with a framework method based on the WHO Health Systems Framework. This analysis will generate statements, that will be sent to the participants in the second round. A third round will be used where consensus is not reached. CONCLUSIONS The findings from this Delphi consensus study will facilitate the widespread implementation of targeted testing for HCV in community pharmacies.
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Affiliation(s)
| | | | | | | | - Deborah Crockford
- Hampshire & Isle of Wight LPC (operating as Community Pharmacy South Central) , Hampshire , UK
| | - Ahmed M El Sharkawy
- Liver Unit, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Stuart McPherson
- Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
- The Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne , UK
| | - Mark Wright
- University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee , Dundee , UK
- Ninewells Hospital, NHS Tayside , Dundee , UK
| | | | | | - Janet Catt
- Kings College NHS Foundation Trust , London , UK
| | - Sital Shah
- Kings College NHS Foundation Trust , London , UK
| | | | - Julia Powell
- Community Pharmacy Surrey and Sussex , Surrey , UK
| | | | | | - Salim I Khakoo
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton , Southampton , UK
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7
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Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, Fontaine G, Conway A, Valencia BM, Bajis S, Presseau J, Ward JW, Degenhardt L, Dore GJ, Hickman M, Vickerman P, Grebely J. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022; 7:426-445. [PMID: 35303490 DOI: 10.1016/s2468-1253(21)00471-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite the goal set by WHO to eliminate hepatitis C virus (HCV) as a public health threat, uptake of HCV testing and treatment remains low. To achieve this target, evidence-based interventions are needed to address the barriers to care for people with, or at risk of, HCV infection. We aimed to assess the efficacy of interventions to improve HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. METHODS In this systematic review and meta-analysis, we searched MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and PsycINFO without language restrictions for reports published between database inception and July 21, 2020, assessing the following primary outcomes: HCV antibody testing; HCV RNA testing; linkage to HCV care; and direct-acting antiviral treatment initiation. We also searched key conference abstracts. We included randomised and non-randomised studies assessing non-pharmaceutical interventions that included a comparator or control group. Studies were excluded if they enrolled only paediatric populations (aged <18 years) or if they conducted the intervention in a different health-care setting to that of the control or comparator. Authors were contacted to clarify study details and to obtain additional population-level data. Data were extracted from the records identified into a pre-piloted and standardised data extraction form and a random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. This study is registered in PROSPERO, CRD42020178035. FINDINGS Of 15 342 unique records identified, 142 were included, which reported on 148 unique studies (47 randomised controlled trials and 101 non-randomised studies). Medical chart reminders, provider education, and point-of-care antibody testing significantly improved at least three study outcomes compared with a comparator or control. Interventions that simplified HCV testing, including dried blood spot testing, point-of-care antibody testing, reflex RNA testing, and opt-out screening, significantly improved testing outcomes compared with a comparator or control. Enhanced patient and provider support through patient education, provider care coordination, and provider education also significantly improved testing outcomes compared with a comparator or control. Integrated care and patient navigation or care coordination significantly improved linkage to care and the uptake of direct-acting antiviral treatment compared with a comparator or control. INTERPRETATION Several interventions to improve HCV care that address several key barriers to HCV care were identified. New models of HCV care must be designed and implemented to address the barriers faced by the population of interest. Further high-quality research, including rigorously designed randomised studies, is still needed in key populations. FUNDING None.
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Affiliation(s)
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, National Infection Service, Public Health England Colindale, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, National Institute for Health Research, London, UK
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anna Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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8
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Busschots D, Bielen R, Koc ÖM, Heyens L, Dercon E, Verrando R, Janssens F, Van den Bergh L, Van Lint P, Bruckers L, Nevens F, Robaeys G. On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era. BMC Public Health 2021; 21:1574. [PMID: 34416867 PMCID: PMC8379886 DOI: 10.1186/s12889-021-11608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11608-9.
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Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Filip Janssens
- Department of Gastroenterology, Jessa Hospital, Hasselt, Belgium
| | - Luc Van den Bergh
- Department of Gastroenterology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Peter Van Lint
- Department of Gastroenterology, AZ Vesalius, Tongeren, Belgium
| | - Liesbeth Bruckers
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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9
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Navarrete J, Yuksel N, Schindel TJ, Hughes CA. Sexual and reproductive health services provided by community pharmacists: a scoping review. BMJ Open 2021; 11:e047034. [PMID: 34312200 PMCID: PMC8314704 DOI: 10.1136/bmjopen-2020-047034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Pharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a broader perspective is needed to position pharmacists as SRH providers. This review explored research that described and evaluated professional pharmacy services across a broad range of SRH areas. DESIGN Scoping review DATA SOURCES: Medline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (January 2007-July 2020). STUDY SELECTION Studies reporting on the description and evaluation of professional pharmacy SRH services provided by community pharmacists. DATA EXTRACTION Two investigators screened studies for eligibility, and one investigator extracted the data. Data were analysed to primarily describe professional pharmacy services and intervention outcomes. RESULTS Forty-one studies were included. The main SRH areas and professional pharmacy services reported were sexually transmitted and bloodborne infections (63%) and screening (39%), respectively. Findings showed that pharmacists' delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users. However, integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations were some of the barriers identified to implementing SRH services. Studies were primarily in specific areas such as chlamydia screening or hormonal contraception prescribing, while studies in other areas (ie, medical abortion provision, long-acting reversible contraception prescribing and vaccine delivery in pregnant women) were lacking. CONCLUSION This scoping review highlights the expansion of pharmacists' roles beyond traditional product-focused services in a number of SRH areas. Given the potential feasibility, users' acceptability and reach, pharmacists are ideally situated to enhance SRH care access. Future research describing implementation and evaluation of professional pharmacy services in all SRH areas is needed to promote access to these services through community pharmacies and position pharmacists as SRH providers worldwide.
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Affiliation(s)
- Javiera Navarrete
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nese Yuksel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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10
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Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy. Clin Res Hepatol Gastroenterol 2021; 45:101564. [PMID: 33740477 DOI: 10.1016/j.clinre.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
Significant steps must be taken to reduce the global incidence and prevalence of hepatitis C virus (HCV) and mortality from HCV infection to achieve the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Proper epidemiological surveillance of the full continuum of care is essential for monitoring progress and identifying gaps that need to be addressed. The tools required for elimination have largely been established, and the issue at hand is more how they should best be implemented in different settings around the world. Documenting good practices allows for knowledge exchange to prevent transmission and improve health outcomes for people with HCV. This review found 13 well documented HCV good practices that have become the standard of care or that should become the standard of care as soon as possible. In 2013, highly effective direct-acting antiviral therapy became available, which has cure rates of over 95%. Together with this new therapy, evidence-based good practices can help countries eliminate viral hepatitis C.
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11
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Byrne C, Radley A, Inglis SK, Beer LJZ, Palmer N, Pham MD, Healy B, Doyle JS, Donnan P, Dillon JF. Reaching m Ethadone users Attending Community p Harmacies with HCV: an international cluster randomised controlled trial protocol (REACH HCV). BMJ Open 2020; 10:e036501. [PMID: 32868356 PMCID: PMC7462226 DOI: 10.1136/bmjopen-2019-036501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is a global public health threat, and novel models of care are required to treat those currently or previously at highest risk of infection, particularly persons who inject drugs (PWID; ever injected), as conventional healthcare models do not have the reach to deliver cure of HCV to disadvantaged, disproportionately affected communities. In Western Europe and Australasia, it is estimated that HCV affects between 0.4% and 1.0% of the regions' populations, accordingly, it affects between 0.4% and 0.7% of the populations of countries in this study (Scotland, Wales and Australia). Reaching mEthadone users Attending Community pHarmacies with HCV (REACH HCV) will evaluate community pharmacy-based diagnostic outreach and HCV treatment against conventional HCV testing and treatment pathways for clients receiving opioid substitution therapy (OST) in community pharmacies. METHODS AND ANALYSIS REACH HCV is an international multicentre cluster randomised controlled trial with sites in Scotland, Wales and Australia. The sites are community pharmacies which are randomised equally to one of two pathways: the pharmacy intervention pathway or the education-only (control) pathway. Participants are recruited from OST clients in these pharmacies.In the pharmacy intervention pathway, participants receive a rapid point-of-care HCV PCR test in their pharmacy by a study outreach nurse. If positive, direct-acting antivirals (DAAs) are delivered to participants via their pharmacist in line with their OST schedule.In the education-only pathway, pharmacists counsel OST clients on HCV and refer them to the nearest nurse-led clinic or general practitioner offering HCV testing according to standard care protocols. If positive, DAAs are delivered as in the intervention pathway.The primary endpoint for both pathways is sustained viral response at 12 weeks post-treatment . Secondary outcomes are: cost-efficacy by pathway; participants tested by pathway; adherence to therapy by pathway and impact of blood test results on treatment decisions.A statistical analysis plan will be finalised prior to data lock. Analysis will be by intention to treat (ITT) to show superiority. Modified ITT analysis will also be undertaken to explore the steps in the pathways. ETHICS AND DISSEMINATION The trial received ethical favourable opinion from the East of Scotland Research Ethics Committee 2 (19/ES/0025) for UK sites and approval from the Alfred Hospital Ethics Committee (148/19) for Australian sites and complies with principles of Good Clinical Practice. Final results will be presented in peer-reviewed journals and at relevant conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT03935906. PROTOCOL VERSION V.4.0-19 March 2020.
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Affiliation(s)
- Christopher Byrne
- Department of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Andrew Radley
- Department of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Directorate of Public Health, National Health Service Tayside, Dundee, UK
| | | | - Lewis J Z Beer
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Nicki Palmer
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, UK
| | - Minh Duc Pham
- Disease Elimination Programme, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brendan Healy
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, UK
| | - Joseph S Doyle
- Disease Elimination Programme, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | - John F Dillon
- Department of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, National Health Service Tayside, Dundee, UK
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12
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Radley A, de Bruin M, Inglis SK, Donnan PT, Hapca A, Barclay ST, Fraser A, Dillon JF. Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial. Lancet Gastroenterol Hepatol 2020; 5:809-818. [PMID: 32526210 DOI: 10.1016/s2468-1253(20)30120-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Highly effective direct-acting antiviral drugs provide the opportunity to eliminate hepatitis C virus (HCV) infection, but established pathways can be ineffective. We aimed to examine whether a community pharmacy care pathway increased treatment uptake, treatment completion, and cure rates for people receiving opioid substitution therapy, compared with conventional care. METHODS This cluster-randomised trial was done in Scottish community pharmacies. Before participants were recruited, pharmacies were randomly assigned (1:1) to refer patients with evidence of HCV antibodies to conventional care or offered them care in the pharmacy (pharmacist-led care). Pharmacies were stratified by location. All pharmacies were trained to offer dried blood spot testing. All eligible participants had received opioid substitution therapy for approximately 3 months, and those eligible to receive treatment in the pharmacist-led care pathway were HCV PCR positive, were infected with HCV genotype 1 or 3, and were willing to have a pharmacist supervise their antiviral drug administration. Neither pharmacists nor patients were masked to treatment allocation. In both groups, assessment blood samples were taken, infection with HCV was confirmed, and daily oral ledipasvir-sofosbuvir (90 mg ledipasivir plus 400 mg sofosbuvir) for 8 weeks for genotype 1 or daily oral sofosbuvir (400 mg) plus oral daclatasvir (60 mg) for 12 weeks for genotype 3 was prescribed by a nurse (conventional care group) or pharmacist (pharmacist-led care group). In the conventional care group, the patient received care at a treatment centre. Once prescribed, medication in both groups was delivered as daily modified directly observed therapy alongside opioid substitution therapy in the participants' pharmacy where treatment was observed on 6 days per week. The primary outcome was the number of patients with sustained virological response 12 weeks after completion of treatment (SVR12) as a proportion of the number of people receiving opioid substitution therapy at participating pharmacies. Participants were monitored at each visit for nausea and fatigue; other adverse events were recorded as free text. Secondary outcomes compared key points on treatment pathway between the two groups. These key points were the proportion of patients having dry blood spot testing, the proportion of patients initiating HCV treatment, the proportion of patients completing the 8 or 12 week HCV course of treatment, and the proportion of patients with sustained virological response at 12 months. This study is registered with ClinicalTrials.gov, NCT02706223. FINDINGS 56 pharmacies were randomly assigned (28 to each group; one pharmacy withdrew from the conventional care group). The 55 participating pharmacies included 2718 patients receiving opioid substitution therapy (1365 in the pharmacist-led care group and 1353 in the conventional care group). More patients met the primary endpoint of SVR12 in the pharmacist-led care group (98 [7%] of 1365) than in the conventional care group (43 [3%] of 1353; odds ratio 2·375, 95% CI 1·555-3·628, p<0·0001). More users of opioid substitution therapy in the pharmacist-led care group versus the conventional care group agreed to dry blood spot testing (245 [18%] of 1365 vs 145 [11%] of 1353, 2·292, 0·968-5·427, p=0·059); initiated treatment (112 [8%] of 1365 vs 61 [4%] of 1353, 1·889, 1·276-2·789, p=0·0015) and completed treatment (108 [8%] of 1365 vs 58 [4%] of 1353, 1·928, 1·321-2·813, p=0·0007). The data for sustained virological response at 12 months are not reported in this study: patients remain in follow-up for this outcome. No serious adverse events were recorded. INTERPRETATION Using pharmacists to deliver an HCV care pathway made testing and treatment more accessible for patients, improved engagement, and maintained high treatment success rates. The use of this pathway could be a key part of an integrated and effective approach to HCV elimination at a community level. FUNDING Partnership between the Scottish Government, Gilead Sciences, and Bristol-Myers Squib.
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Affiliation(s)
- Andrew Radley
- NHS Tayside, Directorate of Public Health, Kings Cross Hospital, Dundee, UK; University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Marijn de Bruin
- Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, Netherlands; University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, UK
| | - Sarah K Inglis
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Peter T Donnan
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Adrian Hapca
- University of Dundee, Tayside Clinical Trials Unit, Dundee, UK
| | - Stephen T Barclay
- NHS Greater Glasgow and Clyde, Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK; Glasgow Caledonian University, Department of Life Sciences, Glasgow, UK
| | - Andrew Fraser
- NHS Grampian, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - John F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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13
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020; 3:165-176. [PMID: 35991853 PMCID: PMC9202783 DOI: 10.3138/canlivj.2019-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/27/2019] [Indexed: 07/29/2023]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist's ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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14
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Evaluación de la precisión diagnóstica del sistema Cobas 6800 para la detección de los niveles de viremia del virus de la hepatitis C a partir de muestras de gotas de sangre seca en papel de filtro. Enferm Infecc Microbiol Clin 2020; 38:267-274. [DOI: 10.1016/j.eimc.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/22/2023]
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15
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020. [DOI: 10.3138/canlivj-2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist’s ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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16
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Enkelmann J, Gassowski M, Nielsen S, Wenz B, Roß S, Marcus U, Bremer V, Zimmermann R. High prevalence of hepatitis C virus infection and low level of awareness among people who recently started injecting drugs in a cross-sectional study in Germany, 2011-2014: missed opportunities for hepatitis C testing. Harm Reduct J 2020; 17:7. [PMID: 31924208 PMCID: PMC6954578 DOI: 10.1186/s12954-019-0338-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Background In Germany, risk of hepatitis C virus (HCV) infection is highest among people who inject drugs (PWID). New injectors (NI) are particularly vulnerable for HCV-acquisition, but little is known about health seeking behaviour and opportunities for intervention in this group. We describe characteristics, HCV prevalence, estimated HCV incidence and awareness of HCV-status among NIs and missed opportunities for hepatitis C testing. Methods People who had injected drugs in the last 12 months were recruited into a cross-sectional serobehavioural study using respondent-driven sampling in 8 German cities, 2011–2014. Data on sociodemographic characteristics, previous HCV testing and access to care were collected through questionnaire-based interviews. Capillary blood was tested for HCV. People injecting drugs < 5 years were considered NI. Results Of 2059 participants with available information on duration of injection drug use, 232 (11% were NI. Estimated HCV incidence among NI was 19.6 infections/100 person years at risk (95% CI 16–24). Thirty-six percent of NI were HCV-positive (thereof 76% with detectable RNA) and 41% of those HCV-positive were unaware of their HCV-status. Overall, 27% of NI reported never having been HCV-tested. Of NI with available information, more than 80% had attended low-threshold drug services in the last 30 days, 24% were released from prison in the last 12 months and medical care was most commonly accessed in hospitals, opioid substitution therapy (OST)-practices, practices without OST and prison hospitals. Conclusion We found high HCV-positivity and low HCV-status awareness among NI, often with missed opportunities for HCV-testing. To increase early diagnosis and facilitate treatment, HCV-testing should be offered in all facilities, where NI can be reached, especially low-threshold drug services and addiction therapy, but also prisons, hospitals and practices without OST.
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Affiliation(s)
- Julia Enkelmann
- Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany. .,European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden. .,Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Martyna Gassowski
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Benjamin Wenz
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stefan Roß
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
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17
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Buchanan R, Cooper K, Grellier L, Khakoo SI, Parkes J. The testing of people with any risk factor for hepatitis C in community pharmacies is cost-effective. J Viral Hepat 2020; 27:36-44. [PMID: 31520434 DOI: 10.1111/jvh.13207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 01/15/2023]
Abstract
New antiviral drugs with high efficacy mean the hepatitis C virus (HCV) can now be eliminated. To achieve this, it is necessary to identify undiagnosed cases of HCV. However, the costs of testing should be considered when judging the overall cost-effectiveness of treatment. This study describes the cost-effectiveness of a community pharmacy testing service in a population of people at risk of HCV living on the Isle of Wight (United Kingdom). Dry blood spot testing was conducted in anyone with a known risk factor for HCV in 20 community pharmacies. The outcomes and costs were entered into a Markov model. Cost and health utilities from the model were used to calculate an incremental cost-effectiveness ratio (ICER). In 24 months, 186 tests were conducted, 13 were positive for HCV RNA and six of these (46%) received treatment during the follow-up period. All achieved a sustained virological response at 3 months. The overall cost of the testing and treatment intervention was £242 183, and the ICER for the service was £3689 per quality-adjusted life year (QALY) gained. If screening had been restricted to just people with a history of injecting drug use (PWID) the ICER would have been £4865 per QALY gained. The service was effective at identifying people with HCV infection, and despite the additional cost of targeted testing, its cost-effectiveness was below the commonly accepted thresholds. In this setting, restricting targeted testing to PWID would not improve the cost-effectiveness.
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Affiliation(s)
- Ryan Buchanan
- Department of Population Science and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Leonie Grellier
- Department of Gastroenterology, St Mary's Hospital, Isle of Wight, UK
| | - Salim I Khakoo
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Department of Population Science and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
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18
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Mason LMK, Veldhuijzen IK, Duffell E, van Ahee A, Bunge EM, Amato‐Gauci AJ, Tavoschi L. Hepatitis B and C testing strategies in healthcare and community settings in the EU/EEA: A systematic review. J Viral Hepat 2019; 26:1431-1453. [PMID: 31332919 PMCID: PMC6899601 DOI: 10.1111/jvh.13182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023]
Abstract
An estimated 9 million individuals are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) across the European Union/European Economic Area (EU/EEA), many of which are yet to be diagnosed. We performed a systematic review to identify interventions effective at improving testing offer and uptake in the EU/EEA. Original research articles published between 1 January 2008 and 1 September 2017 were retrieved from PubMed and EMBASE. Search strings combined terms for HBV/HCV, intervention, testing and geographic terms (EU/EEA). Out of 8331 records retrieved, 93 studies were selected. Included studies reported on testing initiatives in primary health care (9), hospital (12), other healthcare settings (31) and community settings (41). Testing initiatives targeted population groups such as migrants, drug users, prisoners, pregnant women and the general population. Testing targeted to populations at higher risk yielded high coverage rates in many settings. Implementation of novel testing approaches, including dried blood spot (DBS) testing, was associated with increased coverage in several settings including drug services, pharmacies and STI clinics. Community-based testing services were effective in reaching populations at higher risk for infection, vulnerable and hard-to-reach populations. In conclusion, our review identified several successful testing approaches implemented in healthcare and community settings, including testing approaches targeting groups at higher risk, community-based testing services and DBS testing. Combining a diverse set of testing opportunities within national testing strategies may lead to higher impact both in terms of testing coverage and in terms of reduction, on the undiagnosed fraction.
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Affiliation(s)
| | - Irene K. Veldhuijzen
- The Netherlands National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and ControlStockholmSweden
| | - Ayla van Ahee
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | - Eveline M. Bunge
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | | | - Lara Tavoschi
- European Centre for Disease Prevention and ControlStockholmSweden
- Present address:
University of PisaPisaItaly
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Lazarus JV, Pericàs JM, Picchio C, Cernosa J, Hoekstra M, Luhmann N, Maticic M, Read P, Robinson EM, Dillon JF. We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade. J Intern Med 2019; 286:503-525. [PMID: 31472002 DOI: 10.1111/joim.12972] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Globally, some 71 million people are chronically infected with hepatitis C virus (HCV). Marginalized populations, particularly people who inject drugs (PWID), have low testing, linkage to care and treatment rates for HCV. Several models of care (MoCs) and service delivery interventions have the potential to improve outcomes across the HCV cascade of care, but much of the relevant research was carried out when interferon-based treatment was the standard of care. Often it was not practical to scale-up these earlier models and interventions because the clinical care needs of patients taking interferon-based regimens imposed too much of a financial and human resource burden on health systems. Despite the adoption of highly effective, all-oral direct-acting antiviral (DAA) therapies in recent years, approaches to HCV testing and treatment have evolved slowly and often remain rooted in earlier paradigms. The effectiveness of DAAs allows for simpler approaches and has encouraged countries where the drugs are widely available to set their sights on the ambitious World Health Organization (WHO) HCV elimination targets. Since a large proportion of chronically HCV-infected people are not currently accessing treatment, there is an urgent need to identify and implement existing simplified MoCs that speak to specific populations' needs. This article aims to: (i) review the evidence on MoCs for HCV; and (ii) distil the findings into recommendations for how stakeholders can simplify the path taken by chronically HCV-infected individuals from testing to cure and subsequent care and monitoring.
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Affiliation(s)
- J V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J M Pericàs
- Infectious Diseases and Clinical Microbiology Territorial Direction, Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Biomedical Research Institute Dr Pifarré Foundation, Lleida, Spain
| | - C Picchio
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - J Cernosa
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Hoekstra
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - N Luhmann
- Médecins du Monde France, Paris, France
| | - M Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - P Read
- Kirketon Road Centre, Sydney, NSW, Australia
| | - E M Robinson
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
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20
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Biondi MJ, van Tilborg M, Smookler D, Heymann G, Aquino A, Perusini S, Mandel E, Kozak RA, Cherepanov V, Kowgier M, Hansen B, Goneau LW, Janssen HLA, Mazzulli T, Cloherty G, de Knegt RJ, Feld JJ. Hepatitis C Core-Antigen Testing from Dried Blood Spots. Viruses 2019; 11:v11090830. [PMID: 31489933 PMCID: PMC6784259 DOI: 10.3390/v11090830] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
In order to expand hepatitis C virus (HCV) screening, a change in the diagnostic paradigm is warranted to improve accessibility and decrease costs, such as utilizing dried blood spot (DBS) collection. In our study, blood from 68 patients with chronic HCV infection was spotted onto DBS cards and stored at the following temperatures for one week: −80 °C, 4 °C, 21 °C, 37 °C, and alternating 37 °C and 4 °C; to assess whether temperature change during transportation would affect sensitivity. Sample was eluted from the DBS cards and tested for HCV antibodies (HCV-Ab) and HCV core antigen (core-Ag). HCV-Abs were detected from 68/68 DBS samples at −80 °C, 4 °C, 21 °C, and 67/68 at 37 °C and alternating 37 °C and 4 °C. Sensitivity of core-Ag was as follows: 94% (−80 °C), 94% (4 °C), 91% (21 °C), 93% (37 °C), and 93% (37 °C/4 °C). Not only did temperature not greatly affect sensitivity, but sensitivities are higher than previously reported, and support the use of this assay as an alternative to HCV RNA. We then completed a head-to-head comparison (n = 49) of venous versus capillary samples, and one versus two DBS. No difference in core-Ag sensitivity was observed by sample type, but there was an improvement when using two spots. We conclude that HCV-Abs and core-Ag testing from DBS cards has high diagnostic accuracy and could be considered as an alternative to HCV RNA in certain settings.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada.
| | - Marjolein van Tilborg
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands.
| | - David Smookler
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Gregory Heymann
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
| | | | - Stephen Perusini
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | - Erin Mandel
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Robert A Kozak
- Department of Microbiology, Sunnybrook Health Sciences, Toronto, ON M4N 3M5, Canada.
| | - Vera Cherepanov
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
| | - Matthew Kowgier
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Bettina Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
| | - Lee W Goneau
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada
| | - Tony Mazzulli
- Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
- Public Health Ontario Laboratories, Toronto, ON M5G 1M1, Canada.
| | | | - Robert J de Knegt
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands.
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C4 Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Gunn J, Higgs P. Directly observed hepatitis C treatment with opioid substitution therapy in community pharmacies: A qualitative study. Res Social Adm Pharm 2019; 16:1298-1301. [PMID: 31003763 DOI: 10.1016/j.sapharm.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/22/2019] [Accepted: 04/07/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The hepatitis C virus (HCV) will only be eliminated through successful engagement with people who inject drugs (PWID), however some of this population experience socioeconomic and individual issues that can lead to poor HCV treatment adherence. A key sub-group of (PWID) are those who receive opioid substitution therapy (OST). In Australia, OST is most often delivered under direct supervision by a community pharmacist every day or multiple times a week. This regular interaction could be an ideal opportunity to enhance direct-acting antiviral (DAA) treatment adherence under directly observed therapy (DOT) by the pharmacist. AIM The aim of this study was to explore the perspectives of OST patients with a lived experience of HCV to understand whether or not dispensing DAAs in the same way as, or simultaneously with OST would benefit HCV treatment. METHODS Data collection occurred from June to August 2017. Semi-structured interviews were conducted with a sample of PWID living with HCV and on OST programs (n = 12) in Melbourne, Australia. Interviews were voice recorded and transcribed in verbatim. Interpretive phenomenology guided analysis of the data. RESULTS Themes reported by participants that provide insight into the suitability of DOT of DAAs include: Adherence and non-adherence to DAA treatment; Mixed views towards DOT of DAAs; Experiences and perceptions of OST providers; and Perceived stigma in the pharmacy. CONCLUSIONS Community pharmacies offering OST may be an effective place for DOT of HCV treatment, but is likely only to benefit people who face significant challenges to adherence. We suggest that a positive pharmacist-patient relationship, high OST adherence, and commitment to reducing stigma in the pharmacy would be necessary for the intervention to be effective. Further research is needed to evaluate the expanded-role of community pharmacies in improving DAA adherence and eliminating HCV.
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Affiliation(s)
- Jack Gunn
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.
| | - Peter Higgs
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; Department of Public Health, La Trobe University, Melbourne, VIC, Australia
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Scherf-Clavel M, Albert E, Zieher S, Valotis A, Hickethier T, Högger P. Dried blood spot testing for estimation of renal function and analysis of metformin and sitagliptin concentrations in diabetic patients: a cross-sectional study. Eur J Clin Pharmacol 2019; 75:809-816. [PMID: 30706085 DOI: 10.1007/s00228-019-02637-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Dried blot spot (DBS) analysis of drugs or clinical parameters offers many advantages. We investigated the feasibility of using DBS for analysis of anti-diabetic drugs concomitantly with the estimated creatinine clearance (Clcrea). METHODS The cross-sectional study involved physicians in an enabling analysis with 70 diabetic patients and community pharmacists in a field investigation with 84 participants. All 154 DBS samples were analyzed for creatinine, metformin, and sitagliptin. RESULTS The diabetic patients revealed of a wide range of age (32-88 years), BMI values (19.8-54.7 kg/m2), and extent of polypharmacotherapy (1-21 drugs). A correlation factor to convert capillary blood creatinine from DBS into plasma concentrations was determined. Patients' Clcrea ranged from 21.6-155.9 mL/min. The results indicated statistically significant correlations (p < 0.05) between the use of two or three particular drug classes (diuretics, NSAIDs, renin-angiotensin system blockers) and a decreased renal function. DBS concentrations of metformin ranged between 0.23-4.99 μg/mL. The estimated elimination half-life (t ½) of metformin was 11.9 h in patients with a ClCrea higher than 60 mL/min and 18.5 h for diabetics with lower ClCrea. Sitagliptin capillary blood concentrations ranged between 11.12-995.6 ng/mL. Calculated t ½ of sitagliptin were 8.4 h and 13.0 h in patients with a ClCrea above and below 60 mL/min, respectively. CONCLUSIONS DBS allow for the analysis of concentrations of predominantly renally eliminated drugs and community pharmacists can provide a valuable contribution to DBS sampling.
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Affiliation(s)
- Maike Scherf-Clavel
- Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Edwin Albert
- Gemeinschaftspraxis, Ärzte für Allgemeinmedizin, Diabetologie, Marktheidenfeld, Germany
| | - Stephan Zieher
- Gemeinschaftspraxis, Ärzte für Allgemeinmedizin, Diabetologie, Marktheidenfeld, Germany
| | - Anagnostis Valotis
- Stabsstelle Medizinsicherheit, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Thomas Hickethier
- Stabsstelle Betriebsarzt, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Petra Högger
- Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Am Hubland, 97074, Würzburg, Germany.
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Radley A, de Bruin M, Inglis SK, Donnan PT, Dillon JF. Clinical effectiveness of pharmacy-led versus conventionally delivered antiviral treatment for hepatitis C in patients receiving opioid substitution therapy: a study protocol for a pragmatic cluster randomised trial. BMJ Open 2018; 8:e021443. [PMID: 30552244 PMCID: PMC6303565 DOI: 10.1136/bmjopen-2017-021443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/08/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection affects 0.7% of the general population, and up to 40% of people prescribed opioid substitution therapy (OST) in Scotland. In conventional care, less than 10% of OST users are tested for HCV and less than 25% of these initiate treatment. Community pharmacists see this group frequently to provide OST supervision. This study examines whether a pharmacist-led 'test & treat' pathway increases cure rates for HCV. METHODS AND ANALYSIS This protocol describes a cluster-randomised trial where 60 community pharmacies provide either conventional or pharmacy-led care. All pharmacies offer dried blood spot testing (DBST) for HCV. Participants have attended the pharmacy for OST for 3 months; are positive for HCV genotype 1 or 3; are not co-infected with HIV and/or hepatitis B; have no decompensated liver disease; are not pregnant. For conventional care, pharmacists refer HCV-positive participants to a local centre for assessment. In the pharmacy-led arm, pharmacists assess participants themselves in the pharmacy. Drug prescribing is by nurse prescribers (conventional arm) or pharmacist prescribers (pharmacy-led arm). Treatment in both arms is delivered as daily modified directly observed therapy in a pharmacy. Primary trial outcome is number of sustained virological responses at 12 weeks after treatment completion. Secondary trial outcomes are number of tests taken; treatment uptake; completion; adherence; re-infection. An economic evaluation will assess potential cost-effectiveness. Qualitative research interviews with clients and health professionals assess acceptability of a pharmacist-led pathway. ETHICS AND DISSEMINATION This protocol has been ethically approved by the East of Scotland Research Ethics Committee 2 (15/ES/0086) and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Caldicott guardian approval was given on 16 December 2016 to allow NHS Tayside to pass information to the cluster community pharmacies about the HCV test status of patients that they are seeing to provide OST supervision. NHS R&D approvals have been obtained from each health board taking part in the study. Informed consent is obtained before study enrolment and only anonymised data are stored in a secured database, enabling an audit trail. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT02706223; Pre-results.
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Affiliation(s)
- Andrew Radley
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Peter T Donnan
- Tayside Clinical Trials Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Applegate TL, Fajardo E, Sacks JA. Hepatitis C Virus Diagnosis and the Holy Grail. Infect Dis Clin North Am 2018; 32:425-445. [DOI: 10.1016/j.idc.2018.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Radley A, Tait J, Dillon JF. DOT-C: A cluster randomised feasibility trial evaluating d irectly o bserved an t i-H C V therapy in a population receiving opioid substitute therapy from community pharmacy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017. [DOI: 10.1016/j.drugpo.2017.05.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bajis S, Dore GJ, Hajarizadeh B, Cunningham EB, Maher L, Grebely J. Interventions to enhance testing, linkage to care and treatment uptake for hepatitis C virus infection among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:34-46. [DOI: 10.1016/j.drugpo.2017.07.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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Grebely J, Bruneau J, Bruggmann P, Harris M, Hickman M, Rhodes T, Treloar C. Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:26-33. [DOI: 10.1016/j.drugpo.2017.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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