As key providers of services which prevent hepatitis C transmission, community pharmacies are vital players in the UK’s efforts to eliminate hepatitis C by 2030 at the latest.
Predominantly transmitted through the sharing of contaminated drug-taking equipment, hepatitis C affects 118,000 people in the UK. By nature of the route of infection, many of those requiring treatment for hepatitis C are among the most marginalised and vulnerable in our society. This makes hepatitis C – which can lead to liver damage and fatal cirrhosis if left untreated – a major driver of health inequalities. However, it is both preventable and treatable: fantastic medical developments in recent years have meant that anyone can now access fast acting and highly effective drugs on the NHS to clear their hepatitis C infection.
We’ve seen great progress as a result of NHS England’s ‘elimination deal’ with the pharmaceutical companies that produce hepatitis C drugs. This has led to funding for both treatments and projects to find undiagnosed patients, which will be particularly important given that the majority of those living with an active hepatitis C infection do not know they have it.
Despite these advancements, there is still some way to go in the UK’s journey to eliminating hepatitis C by 2030 at the latest, as the Government committed to doing in 2016. As Director of Community Services at The Hepatitis C Trust, I often hear about the challenges people face in accessing hepatitis C care. These vary from a complex treatment pathway, to a reluctance to engage due to previous negative experiences with public services, to barriers caused by unstable housing.
In many instances, pharmacies are in a unique position to override these difficulties because of the relationships they build with people accessing medication assisted treatment (MAT) or needle and syringe programmes (NSP), leading to far higher rates of success in engaging people with other healthcare services. Not only have such services been evidenced as reducing hepatitis C and other blood-borne virus transmission, but by engaging people in testing and treatment pharmacies are supporting those people who are most at risk of having an active hepatitis C infection and passing it on.
Hepatitis C interventions in pharmacies are often more convenient for patients, too. An evaluation of a hepatitis C pharmacy testing pilot run by the London Joint Working Group on Substance Use and Hepatitis C found that almost four in five people accessing the service said they would prefer to collect their medication from a community pharmacy rather than another health setting. With high rates of ‘did not attends’ along the hepatitis C treatment pathway, making services work for patients is critical.
This is why the announcement in 2019 to fund hepatitis C testing for people accessing NSPs in community pharmacies is so welcome. Various pilots have indicated that high proportions of those accessing NSPs in pharmacies have had a hepatitis C infection. Focusing tests on this group is therefore an important step towards more accessible testing and referral pathways for those at greatest risk of this disease.
By providing people with harm reduction services like MAT and NSP as well as offering testing and treatment for hepatitis C, community pharmacies will be crucial to both preventing and treating this disease. Using their relationships built up with people over many months of regular contact, pharmacies can forge care pathways that are flexible and work for patients. For instance, we’ve seen pharmacies which have partnered with other organisations to offer people their treatment in monthly batches or to hold in safe-keeping for them to take daily alongside their MAT – whichever works better for them. This approach of patient-centred care will be fundamental to our success in eliminating hepatitis C within the next few years.
Director of Community Services, Hepatitis C Trust