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The role of community pharmacies in the HIV and HCV care continuum
Sorosh Kherghehpoush1, Kimberly C McKeirnan1
1Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 East Spokane Falls Blvd, Spokane, WA 99202-2131, USA.
Insights
Community pharmacists provided HIV and hepatitis C virus (HCV) testing and counseling to homeless individuals. Pharmacist interventions successfully linked most participants needing care to health clinics, improving health outcomes for this vulnerable population.
Area of Science:
- Public Health
- Infectious Diseases
- Community Pharmacy Practice
Background:
- Over 1.1 million people live with HIV and 2.4 million with HCV in the US.
- 14% of individuals with HIV and nearly half of those with HCV are undiagnosed.
- Homeless populations face disproportionately higher risks of HIV and HCV infection.
Purpose of the Study:
- To evaluate community pharmacist-led interventions for reducing HIV and HCV transmission.
- To promote linkage to care for individuals experiencing homelessness.
- To assess the impact of pharmacist interventions on HIV and HCV prevention and management.
Main Methods:
- A community pharmacy in Spokane, Washington, provided HIV and HCV point-of-care testing (POCT).
- Interventions included risk assessment, education, counseling, and referrals to partner clinics.
- Participants were adults experiencing homelessness, screened for recent testing or diagnosis.
Main Results:
- 44% of participants had reactive HCV POCT, and 1 had reactive HIV POCT.
- 94% reported illicit drug use, with 74% reporting injection drug use.
- 71% of referred participants confirmed establishing care with a health clinic.
Conclusions:
- Homeless individuals are at elevated risk for HIV and HCV due to substance misuse and risky behaviors.
- Pharmacist involvement in HIV and HCV care can improve linkage and retention for hard-to-reach populations.
- PrEP (pre-exposure prophylaxis) is underutilized and pharmacist interventions can address this gap.
Introduction:
In 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care.
Methods:
This study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics.
Results:
Fifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care.
Conclusion:
Individuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.
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