Eliminating Hepatitis C Virus Infections in Individuals who Inject Drugs: A Novel Model of Community Pharmacy Care

Direct-acting antivirals (DAAs) achieve sustained virologic response (SVR) in 95% of patients treated for Hepatitis C virus (HCV) infection.¹ Individuals who inject drugs (PWID) are less likely to access medical care or afford DAAs and may unknowingly continue to spread HCV.² Through public health efforts and initiatives, the Washington State Department of Health hopes to eliminate HCV in the state by the year 2030.³ In a study published in Drug and Alcohol Dependence Reports, the authors report the implementation and success of a pilot program led by community pharmacists to treat HCV infections in PWID in Washington state.⁴ Successful programs like these can serve as a blueprints or models for other states to eliminate HCV infections in PWID.

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The Washington State Department of Health approved the Pharmacist, Physician, and Patient Navigator Collaborative Care Model (PPP-CCM) designed by the authors of the study.⁴ In this model, community pharmacists deliver all aspects of treating HCV infection in PWID. The authors enrolled 40 patients who satisfied the inclusion and exclusion criteria in the single-arm, prospective, observational study. They reported that of the 40 patients enrolled in the study, 38 (95%) achieved the primary outcome of meeting with the pharmacist for initial evaluation.⁴

Regarding secondary outcomes, 21 patients (55%) received DAAs, 16 of these 21 (76%) completed the therapeutic regimen, and 10 of the 11 patients (91%) for whom viral load data was available achieved SVR. The authors also reported that the incidence of engaging in unprotected sex or injecting drugs in the past 30 days decreased significantly in study participants. Study participants who responded to survey questions reported a high degree of satisfaction and a positive experience with the pharmacist.⁴

The authors conclude that the PPP-CCM can help eliminate HCV infections and create positive health benefits in PWID living with HCV infections.⁴

Although the authors report significant benefits in using PPP-CCM to eliminate HCV infection in PWID, several barriers remain for expanding this program to access all PWID. For example, pharmacists under PPP-CCM can provide care only to patients who are not medically complex, which limits enrollment. The authors reported that their study’s sample size was small. In addition, several patients were lost to follow-up during the study duration, and only 11 of the 16 patients who completed the treatment followed up to undergo tests to determine viral load. The authors believe that the availability of less invasive point-of-care testing, expanding the program to other pharmacies, and formulating outreach programs for enrolling more PWID in treatment plans would support the goal of eliminating HCV infections.⁴

Conclusions

The PPP-CCM and associated policy changes by the Washington State Department of Health are positive steps to eliminate HCV infections in individuals who may not have access or resources to afford medical care. Pharmacists in other states should advocate for similar policy changes to allow access to treatment of HCV infections in PWID and willing to undergo additional training to provide all aspects of care to these patients. Policymakers in other states should support and incentivize pharmacies to offer these programs to eliminate HCV infections in PWID.

References

1. US Department of Veterans Affairs: Viral Hepatitis and Liver Disease. Accessed February 6, 2024. https://www.hepatitis.va.gov/

2. Centers for Disease Control and Prevention: Hepatitis C and Injection Drug Use. Accessed February 7, 2024. https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-pwid.pdf

3. Washington State Department of Health: Eliminating Hepatitis C. Accessed February 8, 2024. https://doh.wa.gov/you-and-your-family/illness-and-disease-z/hepatitis-information/hepatitis-c/eliminating-hepatitis-c

4. Tsui JI, Gojic AJ, Pierce KA et al. Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs. Drug Alcohol Depend Rep. 2023 Dec 23;10:100213. doi:10.1016/j.dadr.2023.100213