ABSTRACT
Background: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment initiation are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Method(s): Four community pharmacies known to work with PWUD and provide opioid agonist therapy (OAT) were trained to provide consent and perform point of care HCV antibody screening and given a standardized tool kit of resources. They were supported by a study nurse to link to HCV RNA testing when antibody positive patients were identified, with initiation of HCV treatment offered to those found to be RNA positive. Qualitative interviews were conducted with five pharmacy staff to explore their experiences with HCV testing and treatment and the feasibility of pharmacists in HCV care cascade. Result(s): Pharmacy staff completed 200 HCV OraQuick tests: 64 tested positive for HCV antibodies: 26 people were HCV RNA negative, 23 previously treated and 3 self-cleared, 2 bloodwork is pending. Of the 26 RNA positive participants, 2 are pending treatment start, 24 people have started treatment, with 12 achieving SVR. While treating identified people has been successful, less than half of projected OraQuick tests have been completed. Although the onset of the Covid 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Pharmacists described feeling hesitant about approaching participants, especially after receiving negative responses from clients about HCV testing. Some worried their relationship would change with clients as asking about HCV implied risky drug use. Conclusion(s): This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.
ABSTRACT
Introduction Delivery of the World Health Organisation elimination agenda for Hepatitis C Virus (HCV) requires active case finding, to engage hard to reach risk groups. Surrey is a relatively affluent part of the country, but contains pockets of significant unmet need, which are a barrier to the HCV care cascade. In 2020 the Surrey HCV Operational Delivery Network (ODN) piloted 'pop up clinics' for housed homeless populations during the COVID 19 pandemic. Based on this experience the ODN lead successfully bid for NHS England funding for a Mobile Outreach Van (MOV). Methods Detailed mapping of the ODN was undertaken jointly with the Hepatitis C Trust to identify potential locations to screen e.g., Opiate Substation Therapy dispensing pharmacies, and areas with high numbers of homeless people. MOV procurement and governance obtained in accordance with Trust policy. Individuals complete a brief liver health questionnaire including Blood Bourne Virus (BBV) risk factors. HCV screening is undertaken using Oraquick point of care testing. Those screening HCV Antibody positive (Ab +ve) receive a Clinical Nurse Specialist (CNS) assessment for therapy including a BBV screen HCV PCR and Fibro Scan. Hepatitis C Trust peer support is available to all individuals. Other significant findings prompt onward referral e.g., cirrhosis surveillance. Results First six months of operation the team have undertaken 50 testing days in 16 venues. 761 individuals have accepted HCV Ab screening. 40 (5.2%) tested HCV Ab +ve. 10 individuals confirmed viraemic and eligible for treatment. Another 7 individuals were re-engaged to undertake end of treatment or Sustained Virologic Response 12/48 PCR. In addition, 1 HCV Ab +ve (PCR negative), patient was diagnosed with Human Immunodeficiency Virus and referred to the local sexual health team. 16 individuals identified with advanced fibrosis or cirrhosis were referred to hospital for Hepatocellular Carcinoma surveillance. Patients engaged through the MOV service have received their treatment in the community via this service delivered by a CNS. Conclusions Nurse led MOV screen test treat model has proven to be safe and effective in engaging difficult to reach populations. Hepatitis C Trust peers accessibility help to address the anxiety/stigma surrounding HCV. MOV wider benefits include engagement with drug and alcohol services, and harm reduction. The next phase of implementation, the team plan to deliver needle exchange and naloxone in a partnership agreement with Surrey County Council.
ABSTRACT
Background and aims: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment initiation are required to meet this goal. Novel models have proven successful to engage populations who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care: Tayside, Scotland pharmacy-based HCV screening and treatment has demonstrated excellent outcomes and progress towards local HCV elimination. The EPIC Study seeks to determine whether pharmacybased treatment successes can be replicated at community pharmacies in Victoria BC. Method: Four community pharmacies known to work with PWUD and provide opioid agonist therapy (OAT) were provided training sessions to equip staff with a standardized tool kit of resources. In fall 2020, pharmacy staff were trained to provide verbal informed consent and perform point of care HCV OraQuick antibody screening. Pharmacies were supported by a study nurse to link to HCV RNA testing when antibody positive patients were identified, with initiation of HCV treatment offered to those found to be RNA positive. (Figure Presented) Figure: (: THU296): Antibody responses after the COVID-19 vaccination in patients with AILD and healthy controls. (A-B) The seropositivity rate (A) and titers (B) of anti-RBD-IgG in patients with AILD and healthy controls. (D-E) The seropositivity rate (D) and titers (E) of NAbs in patients with AILD and healthy controls. The distribution of anti-RBD-IgG (C) and NAbs (F) antibody titers over time in patients with AILD and healthy controls. AILD, autoimmune liver disease;anti-RBD-IgG, spike receptor-binding domain IgG antibody;NAbs, neutralizing antibodies. The study nurse worked with pharmacy staff to strategize adherence and support as needed by study subjects. Qualitative interviews have been conducted with five pharmacy staff to explore their experiences with testing and monitoring HCV treatment and the feasibility of involving pharmacists in the HCV care cascade. Results: To date pharmacy staff completed 171 HCV OraQuick tests finding 53 tested positive for HCV antibodies: 23 people were HCV RNA negative, (20 previously treated and 2 self-cleared), 8 unk/LTF. Of the 22 RNA positive participants, 1 is pending treatment start, 21 people have started treatment, with 8 achieving SVR. While great success has been achieved in treating identified people, less than half of projected OraQuick tests have been completed. Although the onset of the Covid 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Pharmacists described feeling hesitant about approaching participants, especially after receiving negative responses from clients about HCV testing. Some worried their relationship would change with clients as asking about HCV implied risky drug use. Conclusion: This innovative and novel approach to HCV therapy in PWUD attempted to use a pharmacy-based approach to find people with limited connection to primary health care to test and treat HCV. Increased training of pharmacy staff related to stigma around drug use and HCV is required both before and ongoing for successful integration of pharmacy-led HCV testing and treatment in Canada.