HCV
Elizabeth Briand
In the United States, approximately 2.4 million people are living with the hepatitis C virus (HCV), including more than 65,000 in Washington state. There, a pharmacist-led clinic is reducing barriers to care and bringing treatment to patients in need in Seattle and surrounding communities.
“The idea came about several years ago as a project to reduce hepatitis C in our community, specifically among people who use injection drugs,” said Kathleen Pierce, PharmD, pharmacy manager for Kelley-Ross Capitol Hill Pharmacy.
Pierce noted that WHO has set a goal of eliminating HCV by the year 2030. “The cure is relatively easy to achieve with the direct acting antiviral hep C medications,” she said.
Treating and curing people who inject drugs is key to controlling the disease, as injection drug use is a primary method of transmission for HCV.
“There are many barriers to care for people who use drugs,” said Pierce. “Increasing low-barrier access to care is absolutely vital to getting these folks the health care they need and deserve. Pharmacists can fill this role and be a part of the solution to eliminate this infectious disease.”
Reaching those in need
The HCV clinic came about after Judith Tsui, MD, an addiction medical specialist at Seattle’s Harborview Medical Center Adult Medicine Clinic, approached the clinical team at Kelley-Ross to collaborate on a study assessing the success of community pharmacists in treating hepatitis C in people who inject drugs.
“The idea was to model the hep[atitis] C clinic on our already existing and very successful pharmacist-run HIV PrEP clinic,” said Pierce. “Dr. Tsui applied for funding for the study through the National Institute on Drug Abuse and we were off and running.”
Although the study has ended, the clinic continues with the help of other committed collaborators.
Working with Tsui, whom Pierce described as a “huge advocate for pharmacists,” allowed the pharmacy team to expand connections to other physicians and care team members who have fleshed out staffing. In addition, the Hepatitis Education Project, a local medical case management and syringe service program, has provided invaluable assistance. Additionally, working with a local supportive housing group has helped the clinic connect with individuals who need help and has provided space in which to see patients.
“This program helps us meet folks where they are already going to be—at a syringe service program or a methadone clinic or their own apartment building—and makes it a one-stop shop,” said Pierce.
Pharmacists make care accessible
Pharmacists have been the not-so-secret weapon in the sustainability and effectiveness of the clinic.
“The pharmacist can provide all sources of care—the medical assessment, the lab draw, even delivering medication—so the patient doesn’t need to navigate complex health care systems,” said Pierce.
“Folks who use drugs often have a lot of competing priorities. When people have to figure out where they will sleep, how they will eat, and how they will avoid going into withdrawal, going to the doctor to get their hep C treated becomes a very low priority. [With this program], we are working on the hardest-to-reach people who tend to be the people who can spread the infection the most.”
For the pharmacists who have participated in the program, the experience has been a meaningful one. “I think it demonstrates the unique role pharmacists can fill in providing multiple aspects of medical care in one step,” said Pierce. And on an individual level, “not only are we able to serve our community in a much-needed way, but we are able to work at the very top of our license and make medical care easy to access for those who need it most.” ■