Implementation and Evaluation of a Collaborative, Pharmacy-Based Hepatitis C and HIV Screening Program

Donald G. Klepser, PhD, MBA; Michael E. Klepser, PharmD; Philip J. Peters, MD; Karen W. Hoover, MD, MPH; Paul J. Weidle, PharmD, MPH

Disclosures

Prev Chronic Dis. 2022;19(12):E83 

In This Article

Abstract and Introduction

Abstract

Introduction: Pharmacy-based HIV and hepatitis C virus (HCV) screening services developed in conjunction with state and local health departments can improve public health through increased access to testing and a linkage-to-care strategy. The objective of this study was to evaluate the impact of implementing HIV and HCV screening in community pharmacies.

Methods: This prospective, multicenter implementation project was conducted from July 2015 through August 2018. Sixty-one pharmacies participated in 3 US regions. We assessed the effectiveness of point-of-care testing, counseling, and disease education for populations at increased risk for HIV and HCV infection through screening programs offered in community pharmacies. Pharmacy customers were offered screening with point-of-care HIV and/or HCV tests. Reactive test results were reported to state or local health departments for disease surveillance.

Results: A total of 1,164 patients were screened for HIV, HCV, or both at the 61 participating pharmacies; the average number of patients screened per pharmacy was 19. Pharmacists conducted 1,479 HIV or HCV tests among the 1,164 patients. Five of 612 (0.8%) HIV tests yielded a reactive result, and 181 of 867 (20.9%) of HCV tests yielded a reactive result.

Conclusion: Patients at increased risk of HIV or HCV can benefit from screening for infection at community pharmacies. Ease of accessibility to testing coupled with a strategy for linkage to care designed for the local community can improve patient care and improve the course of treatment for HIV and HCV.

Introduction

HIV and hepatitis C virus (HCV) have affected millions of people in the US.[1] Although HIV and HCV infections have been historically associated with poor prognoses, advances in treatment have significantly decreased the illness and death associated with these viruses.[2,3] Currently, the primary factor limiting care for people infected with HIV or HCV is the recognition of infection and establishment of care.

In 2018, 14% of people with HIV infection in the US were unaware of their diagnosis.[4] Of those who were diagnosed with HIV infection in 2018, roughly 23% did not receive treatment.[4] Similarly, approximately half of people with chronic HCV infection in the US in 2018 were unaware of their diagnosis. Many people who are aware of their HCV infection never receive treatment because they are either lost to follow-up or do not meet criteria for treatment. That many people with HIV or chronic HCV infection are not receiving treatment is a public health concern.[2,3] One shortcoming of the US health care system is the ability to link to appropriate care a person who receives a positive test result for HIV or HCV. When the establishment of care is left to the patient or managed passively by health care providers, patients may become overwhelmed. As a result, patients often become discouraged and do not receive follow-up care. The lack of follow-up care often results from the confusion created by attempting to navigate a complicated health care system and unclear instructions on how to access health care providers who could manage HIV or HCV infection.

One way to decrease the prevalence of HIV and HCV infection is to increase screening rates among people at increased risk for these infections and improve treatment rates. The National HIV/AIDS Strategy for the United States and the National Viral Hepatitis Action Plan have stressed both increased access to screening and improved linkage to care.[2,3] A care strategy that has been proposed is a "warm" handoff from the health care provider who conducts the screening to the health care provider who initiates and manages treatment. This strategy aims to make entry into care personal and efficient, which can reduce the amount of time to treatment. If more people with HIV and chronic HCV infection establish care and receive treatment, not only will their health outcomes improve but further transmission of HIV and HCV will slow.

Pharmacies are often identified as the most accessible entry point into the US health care system. There are roughly 62,000 retail pharmacies and more than 180,000 pharmacists practicing in community settings in the US. Furthermore, an estimated 91% of all people in the US live within 5 miles of a community pharmacy.[5] Given their accessibility, community pharmacies have been proposed as potential screening sites for HIV and HCV. Studies of pharmacy-delivered HIV or HCV screening services have focused on either HIV or HCV screening, have described the use of nonpharmacy staff members for the screenings, or have described screenings held as special events.[6–11]

Pharmacy-based HIV and HCV screening services developed in conjunction with state and local health departments can improve public health by increasing access to testing and offering a clear linkage-to-care strategy designed for the local community. The objective of this study was to evaluate the impact of implementing HIV and HCV screening services in a community pharmacy setting. This was a proof-of-concept project to demonstrate that testing services could be effectively developed and implemented in pharmacies and provide justification for allowing us to address effect and linkage to care in a future project.

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