Pharmacist-led HCV Treatment Programs Helps Patients Follow Through

A recommendation for all adults in the US to be screened for HCV has increased the need for treatment programs in urban areas.

Bijou Hunt, Sinai Chicago

Bijou R. Hunt, MA

A pharmacist-led program for hepatitis C virus (HCV) treatment could enable patients to achieve a sustained virologic response while adhering to the desired treatment regimen.

The expansion of HCV screening to all adults in the US was officially recommended in March 2020. In part the recommendations increased the need for HCV Treatment programs and guidance for diverse populations.

A team, led by Bijou R. Hunt, MA, Sinai Infectious Disease Center, Sinai Chicago, evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago.

The Study Period

In the study, the researchers gathered data on all patient treatment applications between January 2017 and June 2019. They also assessed outcomes and patient retention in the treatment cascade.

Overall, they identified 203 HCV treatment applications for 187 patients, 49% of which were between the ages of 55-64, 62% of which were male, 67% of which were Black, and 15% of which were Hispanic.

In addition, 87% of the treatment applications were approved, 91% of which were ultimately completed. Of the 161 patients that completed the treatment regimen, 81% attended a sustained virologic response (SVR) follow-up visit. In this patient subgroup, 98% reached SVR.

The largest drop in the treatment cascade was a 19% decline from the beginning of treatment to the ACR follow-up visit.

“The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR,” the authors wrote. “Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.”

Communication for HCV Screenings

Earlier this year, researchers identified the best communication method to enable the most follow-up throughout the treatment plan for HCV screenings.

A team, led by Shivan J. Mehta, assistant professor of Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, evaluated whether opt out framing, messaging incorporating behavioral science concepts or electronic communication increases the prevalence of HCV screening for patients born between 1945-1965.

The study was divided into 2 different cohorts—a substudy (A) that included 1656 patients of 17 primary care clinicians who were randomized to receive either a mailed letter about HCV screening or a similar letter with a laboratory order for HCV screening and a substudy (B) that included 19,837 patients followed by 417 clinicians.

In the final analysis, the researchers found 19.2% of patients in substudy A (95% CI, 16.5-21.9%) completed screening in the letter only cohort and 43.1% (95% CI, 39.7-46.4%) in the letter and order arm completed screening (P <0.001).

In substudy B, 14.6% (95% CI, 13.9-15.3%) of the usual care content patients and 13.6% (95% CI, 13.0-14.3%) of the behavioral science group completed screening (= 0.06).

For the active patient portal participants, 17.8% (95% CI, 16.0-19.5%) completed screening after they received a letter, compared to 13.8% (95% CI, 13.1-14.5%) of the group that received a patient portal message completed screening (<0.001).

The study, “Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019,” was published online in Public Health Reports.

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