A novel way to target hard-to-reach groups with hepatitis C cures would be to allow pharmacists to provide direct acting anti-viral (DAA) therapies to drug users along with methadone, researchers say.
The proposal, presented in Research in Social and Administrative Pharmacy, says Australia’s 2030 target to eradicate HCV will only be achieved by successfully engaging people who inject drugs, a marginalised group with poor access and adherence to treatment via traditional medical clinics.
By homing in on those who were also receiving opioid substitution therapy (OST) under directly observed therapy (DOT) by their pharmacists, there was “an ideal opportunity” to reach some of this core population of people with chronic HCV, according to researchers from the Burnet Institute and La Trobe University, Melbourne.
They note there are currently an estimated 24,000 injecting drug users living with hepatitis C who are also receiving OST such as methadone and buprenorphine.
In interviews with patients receiving OST from a pharmacist, they found many – but not all – were positive about the idea of receiving HCV treatment in a community pharmacy setting.
Patients using OST said co-supply of DAAs would be convenient and would help them to remember their daily medication:
“That would be the best way. Definitely. Getting them both at the same time because then you can’t forget them. You know, because you’re not going to miss too many doses of methadone,” commented one patient.
“That’d be alright. It’s the same [DAA treatment] as going to get your methadone every day, you’ve just gotta remember or else it’s not gonna work… and if you’ve got questions to ask like if the pills have done something, at least you’re going to the pharmacist and he knows,” said another.
Community pharmacies were theoretically an effective place to help increase DAA uptake, the researchers said, but there would also be a number of barriers, such as stigma and negative attitudes from other customers or from pharmacists .
They believed the idea would most likely benefit patients who had poor adherence to DAA treatment.
While recommending future studies around the proposal’s real-world feasibility and benefits, they said there was potential in trialling the model in different settings such as prisons, residential rehab and needle and syringe programs and addiction treatment clinics.
Alluding to the marked decline in DAA uptake since an initial 60,000 patients were cured following the first PBS-listing of DAAs, they emphasised “the importance of trialling new ways to provide … access and ensure no one is left behind”.
“To ensure the 2030 HCV elimination goals are met, it is imperative that providers and policymakers prioritise meeting the healthcare needs of people who inject drugs,” they wrote, recommending further research for an expanded community pharmacy role.