Integrating community pharmacy testing for hepatitis c with specialist care
Linkage to care
Laboratory-based antibody test,Laboratory-based PCR/RNA (confirmatory) test
Background: Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim(s): To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly to specialist care. Service development, design and implementation: Dry blood spot tests were undertaken at community pharmacies for HCV, hepatitis B, HIV and syphilis. Individuals testing positive for HCV RNA or hepatitis B surface antigen were automatically referred to the mainland hepatology service and were seen at a pharmacy 'point-of-diagnosis' consultation with the testing pharmacist and hepatologist. Pharmacy testing activity was compared with the local drug support centre (island recovery integrated service [IRIS]). Service outcomes: Over a period of nine months (September 2014 to May 2015), a total of 88 tests were performed at community pharmacies. Of these, 39 of the individuals tested reported injecting drug use as their main risk factor; 17 of these were not engaged at IRIS and were significantly less likely to have had a previous test (77% vs. 41%, P =0.04). During the same period at the IRIS centre, 34 tests were performed. A greater proportion of individuals had a history of injecting drug use (85%, P <0.01) and were more likely to have had a test in the past three years (56%P, =0.07). Overall, 7% of pharmacy tests and 9% of IRIS tests were positive for HCV RNA (P =0.7); all pharmacy cases were seen at a point-of-diagnosis consultation with a hepatologist Conclusion(s): Pharmacy-based testing has the potential to reach at-risk individuals who are not tested for HCV elsewhere. When combined with integrated specialist referral, it has the potential to reduce the burden of undiagnosed HCV and engage new diagnoses directly with specialist care.