What works in community pharmacy Hepatitis C testing? A consensus statement to guide service implementation


Author: Charlotte Cook, Leila Reid, Andrew Radley, Ahmed Elsharkawy, Salim Khakoo, Julie Parkes, Ryan Buchanan

Theme: Clinical Research Year: 2023

Background:
To reach and maintain the World Health Organization (WHO) target for Hepatitis C (HCV) elimination, accessible testing must be available, particularly for vulnerable populations. Successful pilots have been performed in community pharmacies worldwide, however, these have not been consistently successful or widely adopted. We aim to produce a consensus statement that describes a gold standard community pharmacy HCV testing service.

Methods:
We used a modified Delphi method, published as an a priori protocol. Twenty-four participants were recruited by purposive and chain-referral methods including HCV peers, community and secondary care pharmacists, Hepatitis C Trust representatives, viral hepatitis nurses, local pharmacy leaders, hepatology consultants and treatment network managers. Consensus was reached after three rounds: the first free-text, the second and third rating statements using a 7-point Likert scale. Statements that reached consensus were discussed with a patient and public involvement group and developed into a consensus document. The first round underwent thematic analysis using the WHO Health Systems Framework. Quantitative analysis was used for rounds two and three.

Results:
The response rates were 100%, 96% and 88% for rounds one, two and three respectively. Consensus was reached for 60 statements. Recommendations emphasized the importance of ensuring testing is easily accessible for anyone with a risk factor for HCV (not restricted to small sub-groups); ensuring strong, direct connections between pharmacies and HCV treatment teams; providing automatic polymerase chain reaction testing for antibody positive tests; integrating Hepatitis B and Human Immunodeficiency virus testing alongside HCV; working with peers to engage at-risk clients and strong communication and links between stakeholders.

Conclusion:
We have developed a consensus statement, using a modified Delphi process with a heterogenous panel of participants, describing the blueprint for an effective community pharmacy HCV testing programme. If implemented this will help at-risk populations access testing and the drive towards maintaining elimination.

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