1. Hepatitis C case-finding – An opportunity for community pharmacy
Paul Selby
Lead Pharmacist, Eastern Hepatitis Network ODN

2. Eastern Hepatitis Network ODN
Cambridgeshire & Peterborough
Addenbrooke’s Hospital
Peterborough City Hospital
HCV Prevalence approximately 0.2% of poulation
Over 2,300 patients treated with new direct-acting antivirals (network-wide)
30,000 patients treated nationally (on database; December PHE)

3. Eastern Hepatitis Network ODN
Hub
Sub-hub
Treatment Centre

4. Hepatitis C (HCV)
Hepatitis C (HCV) is A blood-borne virus, spread mainly through blood-to-blood contact
HCV can damage the liver, potentially causing cirrhosis and primary liver cancer
85% of those exposed go on to develop chronic HCV
Chronic HCV leads to cirrhosis or liver cancer in 20% of patients over years1
1. The Pharmaceutical Journal, Vol 299, No 7907, online | DOI: /PJ

5. HCV Treatments New treatments work by inhibiting viral replication
Usually 2 or more different modes of inhibition are used in combination
Treatment length is 8-12 weeks for the majority of patients although some patients may need longer treatment
Treatment success (‘SVR12’) is >90% with various combinations for different genotypes
Treatments are now oral only– no injections

6. Hepatitis C: Elimination
WHO has a target to eliminate HCV by 20301
NHS England has a target to eliminate HCV by 20252
Goal: 90% of ever-infected patients treated
Already achieved:
16% fall in deaths due to HCV3
39% fall in liver transplants due to HCV3
focused action to meet our commitment to reduce the incidence of chronic HCV infection by 80% and HCV mortality by 65% by 2030 at the latest.
modelled estimates that suggest at least 53% of the ever chronically infected population had been diagnosed or successfully treated by While the first WHO target of 50% being diagnosed by 2020 has been met in England, more needs to be done if we are to reach the 90% target by 2030.
1. World Health Organisation (2016). Combating Hepatitis C and B to reach elimination by Geneva: WHO Press.
2. NHS England. NHS England sets out plans to be first in the world to eliminate Hepatitis C. NHS England, 2018 [29/01/19]. Available from:
3. Public Health England. Hepatits C in England: 2019 report. London, Available from:

7. Treatment outcomes
Content removed

8. Patient experience

9. Hepatitis C: Elimination
Not achieved:
113,000 people still chronically infected nationally1
People who inject drugs (PWID) is the most common risk factor (90%)
53% PWID are unaware of HCV status1
Significant barriers for patients accessing testing and treatment
1. Public Health England. Hepatits C in England: 2019 report. London, Available from:

10. Identifying and treating patients
Test
Work-up/ approval
Treat
~12 weeks
8- 16 weeks
Test
Work-up/ approval
Treat
Drug & Alcohol treatment centres
Prisons
GP Surgeries
Hospital (IP/ OP)
Operational Delivery Networks (ODNs)
Hospital (IP/ OP)
‘Outreach clinics’ e.g D&A services
Supply:
Hospitals
Community Pharmacies

11. HCV Testing Antibody test shows if patient ever had HCV infection
HCV RNA shows if the virus is still present
HCV Genotype tells us more about the virus and directs treatment

12. Pilot schemes Hepatitis C testing in Isle of Wight LJWG phase I
LJWG phase II
DOT-C
Super DOT-C
EHN Pharmacist Clinic

13. Verma S, LJWG (2018). HCV testing in NSP Community Pharmacies Pilot Phase I. London. Availble:

14. Location of care

15. Location of care

16. The Future Service expansion for hepatitis C
Testing is key to get patients into services
Testing at needle exchange centres
Testing of OST
Testing of at risk populations
Increase public knowledge
Commissioning of services will be important
Commissioning of treatments prevents community pharmacy dispensing (for now)
Improve links with secondary care providers
Commissioned Testing only at pilot stages
EHN aiming to expand
Increase public awareness of knowledge
Increase pharmacy knowledge ready to act on commissioning changes

17. Future Model Test Referral / Work-up Supply Treat Community Pharmacies
ODNs/ Secondary care
ODNs/ Secondary care
Hospital
GP Surgeries
(genotyping)
Community Pharmacies?
Community Pharmacies
D&AAS
Prisons
GP Surgeries
Hospital clinic
‘outreach’ clinic
NHS England target to eliminate hepatitis C by 2025
Community pharmacy tests patient
GP completes screening (genotype)
Specialist centre approves treatment
Patient receives treatment via community pharmacy and monitored in primary care
Treatment with pan-genotypic

18. What next?
Awareness – briefing document; help patients understand risks, treatments and ease of testing
Engagement – service design; testing pilots
Blood transfusion ‘scandal’