Hepatitis C (HCV) is a blood borne virus that affects the liver and is predominately transmitted by contact with infected blood. In the UK, those at highest risk of contracting HCV are people who inject drugs (PWID), with national data demonstrating PWID account for over 90% of all HCV infections. Since 2014, direct-acting, all oral antiviral treatments have revolutionized the treatment of HCV as well as mitigating complications such as liver failure, liver cancer and the need for liver transplantation. Direct-acting antivirals (DAAs) are effective in curing the infection in more than 90% of those infected with HCV of all genotypes, thus making the HCV elimination targets of the World Health Organisation (WHO) by 2030 and NHS England by 2025 achievable.

Despite this, diagnosis and treatment rates in HCV positive people who are actively injecting remain low. This vulnerable group faces many barriers to access existing services and need more accessible testing and treatment pathways given their high risks of HCV transmission and acquisition. The LJWG’s phase 1 pharmacy pilot offered HCV antibody testing to PWIDs accessing needle and syringe programmes (NSPs) at specific community pharmacies and provided pathways to secondary care for treatment.

The LJWG’s pharmacy testing pilot, phase 2, builds on learning from phase 1 in order to increase testing and treatment for those most at risk of HCV acquisition and transmission. Phase 2 provides point of care capillary blood testing for HCV RNA to PWIDs accessing NSPs from community pharmacies in London, whereas phase 1 tests provided on-the-spot HCV antibody testing. This change enables those with chronic HCV infection to be identified directly in the pharmacies. Both pilots aimed to ensure transition to treatment with pathways from NSP community pharmacies to tertiary treatment centres.

Six pharmacies providing NSPs across London took part in the phase 2 pilot between April 2018 and March 2019. Key findings were:
• Of the 308 patients offered HCV testing across all sites, 57% accepted (n=176).
• 38% (n = 66) tested positive for HCV, of whom 21% completed treatment (n=14).
• 29% (n=51) of those tested did not know that interferon-free treatment was available.
• 78% (n=137) of those tested would prefer to receive HCV treatment in their community pharmacy, followed by 9% (n=16) reporting they would prefer to receive treatment from a GP practice.
• Over three-quarters (78%) of people reported having previously been tested for HCV, and 41% said they had been tested within the last year.
• 75% (n=132) of service users said they would recommend the pharmacy testing service to a friend.

Following on from the success of the phase 1 pilot conducted in 2017-18, this report confirms the feasibility and value of offering point of care HCV diagnosis to PWIDs attending community pharmacies for needle exchange services. This report provides valuable insights for future HCV testing programmes in pharmacies and recommends a broader roll-out.