University of Illinois Hospital and Health Sciences System
Clinical Associate Professor
University of Illinois at Chicago College of Pharmacy
Michelle T. Martin, PharmD, FCCP, BCPS, BCACP, has disclosed that she has received consulting fees and funds for research support from Gilead Sciences and has ownership interest in AbbVie, Gilead Sciences, and Merck.
In 2016, the WHO’s Global Health Sector Strategy on viral hepatitis set a goal to eliminate viral hepatitis as a major public health threat by 2030. Among the plans laid out to help achieve this goal were increasing the rates of HCV diagnosis and linkage to care to expand treatment coverage and reduce further transmission. To eliminate a virus that affects 2.4 million patients in the United States, we must launch a multifaceted attack. Pharmacists can play a critical role in these efforts.
National Goals for HCV Diagnosis
How can we eliminate HCV if we do not know who has it? It is estimated that only 50% of persons living with HCV in the United States are aware of their infection. Clearly, diagnosis is the largest gap in the cascade of HCV care. The goals set forth by the National Academies of Sciences’ Committee on a National Strategy for the Elimination of Hepatitis B and C include a 90% reduction in HCV incidence (vs 2015 data) and a 65% reduction in HCV-related mortality. To meet these goals, the Committee outlined specific target numbers for HCV diagnoses: 110,000/year through 2020, nearly 89,000/year between 2020 and 2024, and more than 70,000/year between 2025 and 2030. These target diagnosis rates require widespread HCV screening.
Integrating HCV Screening Into Practice Workflows
HCV screening is recommended for all persons with risk factors for infection and for those born between 1945 and 1965. However, universal HCV screening could help to address recent trends toward a bimodal distribution of HCV infection across age groups in the United States, with the second incidence peak that has emerged primarily as a result of younger individuals acquiring infection via injection drug use in the ongoing opioid epidemic. Universal screening of pregnant women is also recommended. Diagnosis is simplified with the use of HCV antibody–to–viral load reflex testing. Protocols must be developed and implemented across practice sites to ensure that patient screening is incorporated into the workflow and that diagnosed patients are linked to care. Because pharmacists practice in numerous healthcare settings, they are well positioned to lead the team and provide education across clinic personnel to ensure appropriate screening and management of patients.
Pharmacists on the Frontline
Pharmacists are highly accessible healthcare providers; approximately 90% of Americans live within 5 miles of a community pharmacy. Many baby boomers take prescription medications and regularly visit a community pharmacy. Some patients also interact with clinical pharmacists in an ambulatory care or inpatient setting. To help expand HCV screening nationwide, community pharmacists can implement a fingerstick HCV antibody screening into their workflow. This should only be implemented after developing a linkage to care procedure that will ensure patients have ready access to follow-up with a provider for confirmatory testing in the event of a positive HCV antibody test. Challenges do exist—the pharmacy must consider the cost of the screening test and the time required to counsel patients and link them to care. In some cases, grants may be available to support increased HCV screening.
Ambulatory pharmacists can work with other providers to set up HCV screening and linkage to care protocols within their healthcare teams. Emergency departments and primary care clinics are examples of locations where HCV screening has been successfully implemented with teams that include pharmacists. Offering screening in other specialties, such as psychiatric and drug rehabilitation centers and women’s health clinics, can further increase the identification of patients with HCV infection.
Every diagnosis made from implementing an HCV screening service is important, as diagnosis is the first step in HCV elimination: It allows the patient an opportunity to be treated and cured. Pharmacists can assist with screening and provide education regarding transmission to assist with public health efforts in HCV elimination.
Pharmacists: What steps are you currently taking or do you plan to take to make progress toward implementing HCV screening in your work setting?
Other healthcare providers: How can pharmacists help increase HCV screening at your practice sites?
I invite you to join the conversation by leaving your thoughts and anecdotes in the discussion section below.