Survey Highlights Critical Role of Pharmacists in HCV Management

As modeling estimates indicate, the United States will not meet its hepatitis C virus (HCV) elimination goal by 2030, but a new survey found pharmacists play a key role in HCV treatment, counseling, and management across many healthcare settings.¹

The survey involved 209 respondents across 45 US states, who reported managing approximately 24 patients per month with more than 5 years of experience treating HCV, suggesting the important role of pharmacists in direct HCV patient care.

“Pharmacists are already playing key roles in HCV management at the local, national, and international levels,” wrote the investigative team, led by Michelle T. Martin, PharmD, University of Illinois Chicago College of Pharmacy. “Our survey data demonstrate a variety of pharmacists’ roles in HCV management across many healthcare settings, including in HCV screening and treatment efforts.”

New models point to 2037 as a potential timeline for HCV elimination, given the decline in HCV treatment, with increasing rates of new infections.² In the US, the incidence of acute HCV infection doubled between 2013 and 2021, with the COVID-19 pandemic further impacting screening and treatment efforts.³

Joint HCV guidelines from the American Association for the Study of Liver Diseases and Infectious Diseases Society of America (AASLD-IDSA) promote a treatment approach to enact widespread treatment with direct-acting antiviral (DAAs) and expand care to non-specialist settings.⁴ Pharmacists are the most accessible healthcare provider to most (88.9%) Americans and can be a part of the interdisciplinary liver clinic teams.

However, Martin and colleagues indicated the available literature lacks insight into the national landscape of pharmacist involvement in HCV management, providing reasoning for the current cross-sectional survey study.1 Open-ended questions (n = 30) examined the setting, screening, prescribing, and management of HCV, as well as perceived barriers and facilitators of the expanding role of pharmacists in HCV care.

These questions were sent to 20 electronic mailing lists spanning major pharmacy professional organizations and liver and hepatitis organizations, with 28 days allotted to complete the questionnaire. Ultimately, 259 responses were received, of which 209 were usable—most (66%) pharmacist respondents received HCV training outside of pharmacy school education.

Among the study population, 157 (81%) of 194 pharmacists reported providing screening, linkage to care, and/or referral for HCV evaluation. Almost all survey responses (99.5%; n = 190 of 191) revealed the pharmacist performed treatment evaluation and selection, with more than half (52%) independently selecting an HCV treatment regimen for a patient.

Moreover, nearly all pharmacists (98%; n = 180 of 183) indicated their involvement with HCV treatment education, including patients, caregivers, or family members (98%), and other healthcare team members (90%). Most pharmacists (93%) reported initiating patients on HCV treatment, with most (90%) providing on-treatment or post-treatment monitoring.

From the open-ended questions on satisfying and frustrating aspects of the role, approximately 74% (n = 117 of 158) responses identified cure as the most satisfying part, while socioeconomic factors impacting patient follow-up were frequently (49%; n = 76 of 155) identified as a frustration.

Moreover, Martin and colleagues found collaboration with prescribers (45%), support in the prior authorization process (17%), and administrative support (13%) were identified as the most helpful facilitators for HCV care. On the other hand, the most frequently identified barriers to HCV care included lack of reimbursement (31%), limitations of state laws (23%), and competing pharmacy roles (19%).

“Our study results highlight the extensive role that pharmacists have in HCV management,” Martin and colleagues wrote. “The HCV epidemic is a public health crisis that requires collaboration and engagement of all public health providers.”

References

1. Martin MT, Hietpas AR, Novak JL, Deming P. A National Survey of Pharmacist Involvement in Hepatitis C Virus Management in the United States. J Viral Hepat. 2024 Oct 22. doi: 10.1111/jvh.14014. Epub ahead of print. PMID: 39435734.

2. Sulkowski M, Cheng WH, Marx S, Sanchez Gonzalez Y, Strezewski J, Reau N. Estimating the Year Each State in the United States Will Achieve the World Health Organization's Elimination Targets for Hepatitis C. Adv Ther. 2021 Jan;38(1):423-440. doi: 10.1007/s12325-020-01535-3. Epub 2020 Nov 3. PMID: 33145648; PMCID: PMC7609357.

3. Kaufman HW, Bull-Otterson L, Meyer WA 3rd, Huang X, Doshani M, Thompson WW, Osinubi A, Khan MA, Harris AM, Gupta N, Van Handel M, Wester C, Mermin J, Nelson NP. Decreases in Hepatitis C Testing and Treatment During the COVID-19 Pandemic. Am J Prev Med. 2021 Sep;61(3):369-376. doi: 10.1016/j.amepre.2021.03.011. Epub 2021 May 10. PMID: 34088556; PMCID: PMC8107198.

4. AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis. 2018 Oct 30;67(10):1477-1492. doi: 10.1093/cid/ciy585. PMID: 30215672; PMCID: PMC7190892.