Clinical Pharmacists Deliver Positive Hep C Adherence

Achieving the goals of the National Viral Hepatitis Action Plan 2020 depends upon integrating additional healthcare providers to expand access to hepatitis C virus (HCV) screening and medication treatments. 

This Health and Human Services (HHS) Plan says ‘everyone has a role to play in the battle against viral hepatitis.’

And this ongoing battle is extensive. 

An estimated 4.4 million Americans are living with chronic viral hepatitis infection and are at increased risk for liver disease, liver cancer, and death. 

A new study’s results indicate clinical pharmacists may be the right provider, located at optimal locations to optimize HCV medication use and improve clinical outcomes. 

This study published on July 3, 2019, found HCV treatments delivered by clinical pharmacists resulted in high Sustained Virologic Response (SVR) rates, comparable with care delivered by specialists.

These researchers reported 95.1 percent of patients in the per-protocol population demonstrated positive SVR, whereas 86.1 percent of the intent-to-treat population demonstrated SVR. 

This data compares with those study participants with full adherence had an SVR of 90 percent. 

“This is just the newest study highlighting the benefit of having pharmacists on the healthcare team," said Chris Felton, PharmD, Clinical Pharmacist for Brookshire Grocery Company.  

“When pharmacists are involved in direct patient care, patient outcomes are significantly improved, patients are more adherent to therapies, and healthcare costs go down," concluded Felton.

A previous study published in January 2019 by The Lancet found offering Direct-Action-Antivirals (DAAs) at time of diagnosis could prevent 640,000 deaths from cirrhosis and liver cancer around the world. 

This study concluded that offering a comprehensive package of prevention, screening, and DAA treatment interventions could avert 15.1 million new HCV infections compared with the 2015 baseline.   

Hepatitis C is a blood-borne virus infecting the liver, caused by the Hepatitis C virus, says the Centers for Disease Control and Prevention (CDC).

This is important news since about 70–85 percent of people who become infected with Hepatitis C, the disease becomes a long-term, chronic infection.

But, there is some good news too.

Over 90 percent of HCV infected persons can be cured of HCV infection regardless of genotype, with 8-12 weeks of oral therapy, says the CDC. 

Moreover, the Affordable Care Act has made health insurance more accessible and provides coverage for preventive services including hepatitis C screening. 

Chronic Hepatitis C is a serious disease that can result in long-term health problems, even death. Chronic liver disease in HCV-infected people is usually insidious, progressing slowly without any signs or symptoms for several decades. 

The majority of infected persons might not be aware of their HCV infection because they are not clinically ill. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs. 

In fact, HCV infection is often not recognized until asymptomatic people are identified as HCV-positive when screened for blood donation or when elevated alanine aminotransferase (a liver enzyme) levels are detected during routine examinations. 

Unfortunately, there is no preventive vaccine for Hepatitis C, which means disease management is very important. 

The CDC recommends HCV testing for people who are:

• Current or former injection drug users, including those who injected only once many years ago,
• Everyone born from 1945 through 1965,
• Recipients of clotting factor concentrates made before 1987 when less advanced methods for manufacturing those products were used,
• Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donations, became available.

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This study was conducted a multicenter retrospective cohort study, which included 1,253 patients who initiated DAAs between Jan. 1, 2014, and March 12, 2018, at Creighton University, Temple University Health System, University of Illinois Hospital and Health Sciences System and Vanderbilt University Medical Center.

Drs. Koren, Martin, Teply, and Zuckerman designed the study, performed data collection, and wrote and revised the manuscript. They underscored that this was the first study to demonstrate the efficacy of using such a model across multiple institutions that serve a large and diverse patient population. All authors gave final approval and are accountable for the information presented. No conflicts of interest were disclosed.

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