'I Just Never Wanted Them to Feel Uncomfortable -Barriers to Pharmacy-Based Identification and Treatment of Hepatitis C in Victoria, British Columbia

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.