Pharmacist Involvement in Hepatitis C Management and Time to Treatment Initiation in Medically Underserved Primary...

Although the existing literature highlights the success of pharmacist-led hepatitis C virus (HCV) treatment, the impact of these models on time to treatment initiation has not been studied. This study compared outcomes for HCV treatment using direct-acting antivirals (DAAs) in 2 groups: pharmacist-led programs in 5 federally qualified health centers in Ohio and an external cohort from an out-of-state academic medical center. We assessed the time to HCV treatment initiation, rates of DAA initiation, and sustained virologic response (SVR) rates.

We conducted a retrospective cohort analysis using electronic health records and pharmacy claims for patients with HCV referred to pharmacists from November 2021 through December 2023. We collected data on demographic characteristics, pre-entry characteristics, treatment initiation rates, time to initiation, and cure rates. The treatment initiation rate included all patients referred to a pharmacy. We defined time to initiation as the period from pharmacy referral to the date of medication pickup. We defined cure as achieving SVR 12 weeks posttreatment (SVR12) and analyzed SVR12 rates in an intent-to-treat and per-protocol manner. We compared time to initiation with an external cohort median of 300 days.

Of 477 referred patients, 317 (66.5%) initiated DAAs. The mean (SD) time to treatment initiation was 63.7 (74.2) days, with a median of 37 days. Among the 212 patients completing SVR12 laboratory tests, 194 achieved cure, yielding a per-protocol SVR12 of 91.5% and an intent-to-treat SVR12 of 61.2%. Patients without (vs with) health insurance and with (vs without) a history of substance abuse had longer treatment delays.

This study demonstrates the value of integrating pharmacists into HCV treatment teams to meet public health needs.