This month the London Joint Working Group on Substance Use and Hepatitis C published results of an innovative pilot project that offered point-of-contact hepatitis C testing to people who use needle exchange services in 8 community pharmacies across London. More than half of those tested (53%) had hepatitis C antibodies and were referred directly into specialist services via newly created referral pathways for further tests and for potentially life-saving treatment. Of those engaging with specialist services, 78% had detectable hepatitis C virus particles in their blood and 33% had advanced liver disease with cirrhosis.
Whilst the scale of this pilot is small, its implications are huge. Hepatitis C is a serious public health issue in London. Public Health England estimate there are more than 40,000 people living with the virus and around half of these people are undiagnosed.
This has implications at both an individual and societal level. The long term complications of hepatitis C are serious unless treated, resulting in complications such as liver cancer, cirrhosis, liver failure necessitating liver transplantation, and death. There are NICE approved antiviral treatments available that can cure the virus in more than 95% of patients. Of these undiagnosed patients, those at highest risk of contracting and transmitting the virus are people who inject drugs and yet their engagement with healthcare services is at best sporadic. Hence a need for more innovative, patient-centred, holistic approaches to increase rates of diagnosis in this vulnerable, young, socially marginalized population and to support them into and through hepatitis C treatment.
Our pilot project highlighted that one of the potential barriers to treatment amongst people who inject drugs was the misconception regarding the treatment itself: more than half of those tested (57%) did not know hepatitis C treatment was now interferon-free. Furthermore only 27% of those referred to specialist services attended their appointment, and yet 84% of participants reported that they would like to receive hepatitis C treatment but at the community pharmacy.
Community pharmacies can help
With the curative treatments available, we have the tools to eliminate hepatitis C in the UK, but we must find new ways of diagnosing and supporting people into treatment. Provision of testing and treatment in community pharmacies offers a potential, patient-centred strategy to eliminate hepatitis C as a major public health issue amongst this vulnerable population. Pharmacists often have a good relationship with their service users who are unwilling to engage with GP or other healthcare services. This relationship is a trusted one and offers a golden opportunity to provide testing and potential life-saving treatment to people who would otherwise miss out.
Already we have started working with colleagues in Manchester and Birmingham, sharing our learnings to set up local hepatitis C pharmacy testing pilots to support their communities and determine the transferability of this model. Our next steps in London are to roll out a larger scale pilot of testing, with the potential of offering hepatitis C treatment through community pharmacies.
You can read more about the pilot here.