Pharmacists Combat Rising Hepatitis C Rates
By Myles Starr
The CDC has tracked an increase in hepatitis C virus (HCV) cases over the past decade, but efforts to reduce infections are failing to meet their targets. Data presented at the ASHP Midyear 2024 Clinical Meeting & Exhibition, in New Orleans, outline how pharmacist-led programs can help increase detection and treatment of HCV infections (poster 4-051).
“Acute HCV infection continues to rise (in part) due to lack of awareness and screening services and challenges in linkage to care and medication access,” explained poster author Amanuel Kehasse, PharmD, PhD, the manager of clinical programs at Clearway Health, in Boston. To address these issues, he said, “Clearway Health conceptualized a pharmacist-led, technology-supported HCV micro-elimination program. This program is designed to expand screening services, minimize attrition in the HCV treatment cascade and maximize the cure rate, and eventually contribute toward the 2030 National Strategic Plan [for reducing HCV rates].”
The interventional arm of the study included patients 18 years of age and older who had a hepatitis screening through a single Clearway Specialty Pharmacy from January through May 2024. Data from these tests were exported to a pharmacist-monitored dashboard. Pharmacists then spearheaded referral of eligible patients who tested positive to an HCV clinic as well as facilitating medication access, therapy initiation, adverse event management and treatment outcome monitoring. Control group data, which documented HCV screening and treatment at the same Clearway Specialty Pharmacy during the five months preceding the intervention’s launch, were sourced from the pharmacy’s electronic health records (EHRs).
In the active-intervention group, 1,772 unique patients were screened for HCV, yielding a 5.8% (n=104) antibody positivity rate. Subsequent HCV RNA testing resulted in a 46.1% (n=48) detectable HCV RNA result, of which 67% of patients were linked to care. Compared with patients in the control group, those in the interventional group had a 20% increase in screening volume and 116% increase in linkage to HCV treatment.
The most common reason for a patient who tested positive not being linked to care through this program was clinical deferral, due to comorbidities or patient readiness for treatment. Historically, clinical deferral has been caused by a provider’s assessment that a patient is not ready or able to complete treatment. However, new approaches to HCV care see treatment as a means of prevention. “Pharmacists can play key role in this regard as well,” Dr. Kehasse said, explaining that as this new approach is adopted, it will be possible to link more patients with proper education and support to help them adhere to a treatment plan, receive care and lower HCV rates.
Despite the program’s success and potential applicability to other health systems, Dr. Kehasse noted several hurdles for its implementation, including:
- the need to build HCV screening best-practice alerts into the EHR, thus integrating HCV screening into routine care;
- the burden of developing a systemwide automated HCV screening lab result reporting system; and
- a need to supply provider education/engagement to introduce the pharmacist-led program and create the referral process.
Despite these challenges, he noted that “with the right expertise and technological support, replicating the pharmacist-led HCV Test-to-Treat program is doable.” Accordingly, Clearway has implemented the program in four other health systems with similar initial success and aims to provide multisite real-world evidence of the program’s impact across health systems.
Dr. Kehasse reported no relevant financial disclosures.