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Expanding Hepatitis C Virus Care and Cure: National Experience Using a Clinical Pharmacist–Driven Model

Expanding Hepatitis C Virus Care and Cure: National Experience Using a Clinical Pharmacist–Driven... BackgroundThe US National Viral Hepatitis Action Plan depends on additional providers to expand hepatitis C virus (HCV) treatment capacity in order to achieve elimination goals. Clinical pharmacists manage treatment and medication within interdisciplinary teams. The study’s objective was to determine sustained virologic response (SVR) rates for clinical pharmacist–delivered HCV therapy in an open medical system.MethodsInvestigators conducted a multicenter retrospective cohort study of patients initiating direct-acting antivirals from January 1, 2014, through March 12, 2018. Data included demographics, comorbidities, treatment, and clinical outcomes. The primary outcome of SVR was determined for patients initiating (intent-to-treat) and those who completed (per-protocol) treatment. Chi-square tests were conducted to identify associations between SVR and adverse reactions, drug–drug interactions, and adherence.ResultsA total of 1253 patients initiated treatment; 95 were lost to follow-up, and 24 discontinued therapy. SVR rates were 95.1% (1079/1134) per protocol and 86.1% (1079/1253) intent to treat. The mean age (SD) was 57.4 (10.1) years, the mean body mass index (SD) was 28.7 (6.2) kg/m2, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% were genotype 1, and 81.6% were treatment-naïve. Patients missing ≥1 dose had an SVR of 74.9%; full adherence yielded 90% (P < .0001).ConclusionsHCV treatment by clinical pharmacists in an open medical system resulted in high SVR rates comparable to real-world studies with specialists and nonspecialists. These findings demonstrate the success of a clinical pharmacist–delivered method for HCV treatment expansion and elimination. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Open Forum Infectious Diseases Oxford University Press

Expanding Hepatitis C Virus Care and Cure: National Experience Using a Clinical Pharmacist–Driven Model

Koren, David E; Zuckerman, Autumn; Teply, Robyn; Nabulsi, Nadia A; Lee, Todd A; Martin, Michelle T
Open Forum Infectious Diseases , Volume 6 (7): 1 – Jul 3, 2019
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References (68)

Publisher
Oxford University Press
Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
eISSN
2328-8957
DOI
10.1093/ofid/ofz316
Publisher site
See Article on Publisher Site

Abstract

BackgroundThe US National Viral Hepatitis Action Plan depends on additional providers to expand hepatitis C virus (HCV) treatment capacity in order to achieve elimination goals. Clinical pharmacists manage treatment and medication within interdisciplinary teams. The study’s objective was to determine sustained virologic response (SVR) rates for clinical pharmacist–delivered HCV therapy in an open medical system.MethodsInvestigators conducted a multicenter retrospective cohort study of patients initiating direct-acting antivirals from January 1, 2014, through March 12, 2018. Data included demographics, comorbidities, treatment, and clinical outcomes. The primary outcome of SVR was determined for patients initiating (intent-to-treat) and those who completed (per-protocol) treatment. Chi-square tests were conducted to identify associations between SVR and adverse reactions, drug–drug interactions, and adherence.ResultsA total of 1253 patients initiated treatment; 95 were lost to follow-up, and 24 discontinued therapy. SVR rates were 95.1% (1079/1134) per protocol and 86.1% (1079/1253) intent to treat. The mean age (SD) was 57.4 (10.1) years, the mean body mass index (SD) was 28.7 (6.2) kg/m2, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% were genotype 1, and 81.6% were treatment-naïve. Patients missing ≥1 dose had an SVR of 74.9%; full adherence yielded 90% (P < .0001).ConclusionsHCV treatment by clinical pharmacists in an open medical system resulted in high SVR rates comparable to real-world studies with specialists and nonspecialists. These findings demonstrate the success of a clinical pharmacist–delivered method for HCV treatment expansion and elimination.

Journal

Open Forum Infectious Diseases – Oxford University Press

Published: Jul 3, 2019

Keywords: hepatitis C virus; clinical pharmacists; HCV elimination; direct-acting antiviral; interdisciplinary

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