Facilitating access to direct-acting antivirals in a community-based point-of-diagnosis model for hepatitis C treatment: The role of the pharmacy team in the no one waits (NOW) study

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-03-14 DOI:10.1016/j.drugpo.2025.104768

Colleen A. McGourty , Diana Ung , Mackenzie Clark , Jennifer Nguyen , Claire McDonell , Annie Luetkemeyer , Jeff McKinney , Jennifer C. Price , Meghan D. Morris

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引用次数: 0

Abstract

Background

Despite simplified hepatitis C virus (HCV) treatment algorithms, insurance-related barriers prevent same-day HCV treatment upon diagnosis in the US. We assessed how direct partnerships with a pharmacy team facilitated HCV treatment initiation among socially marginalized populations in a community setting.

Methods

The No One Waits (NOW) Study, a single-arm trial conducted between July 1, 2020, and October 31, 2021, in San Francisco, CA, targeted individuals experiencing homelessness, injecting drugs, and eligible for simplified HCV treatment. Upon positive HCV RNA results, participants were enrolled in same-day treatment and given a 2-week sofosbuvir/velpatasvir (SOF/VEL) starter pack. Additional insurance-provided SOF/VEL was requested for 12 weeks of treatment. If insurance-provided medication was unavailable, SOF/VEL was provided using the study supply. We describe the sustained partnership with a specialty pharmacy team that was necessary for the NOW model's success.

Results

Eighty-seven participants started treatment at diagnosis. Most were unsheltered (61 %), actively injecting drugs (80 %), and had incomes below the federal poverty line (97 %). 90 % transitioned to insurance-covered treatment before completion, with pharmacy members assisting participants in navigating insurance authorization, medication transport, and financial assistance.

Conclusion

A sustained partnership with a specialty pharmacy team was critical in transitioning participants to insurance-covered treatment quickly and overcoming barriers, while the study-provided 2-week starter pack facilitated same-day treatment at the point of diagnosis.

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背景尽管简化了丙型肝炎病毒（HCV）治疗算法，但在美国，与保险相关的障碍阻碍了确诊后当天的 HCV 治疗。我们评估了在社区环境中，与药房团队的直接合作如何促进社会边缘人群开始接受丙型肝炎病毒（HCV）治疗。方法 "无人等待（NOW）研究 "是一项单臂试验，于 2020 年 7 月 1 日至 2021 年 10 月 31 日在加利福尼亚州旧金山进行，目标人群是无家可归、注射毒品且符合丙型肝炎病毒（HCV）简化治疗条件的个人。一旦 HCV RNA 结果呈阳性，参与者将接受当天治疗，并获得为期两周的索非布韦/韦帕他韦（SOF/VEL）启动包。在 12 周的治疗过程中，参试者还需要额外服用由保险公司提供的 SOF/VEL。如果无法获得保险提供的药物，则使用研究供应品提供 SOF/VEL。我们介绍了与专科药房团队的持续合作关系，这种合作关系是 NOW 模式取得成功的必要条件。大多数人没有住所（61%），积极注射毒品（80%），收入低于联邦贫困线（97%）。90%的参与者在完成治疗前过渡到了保险支付的治疗，药房成员协助参与者办理保险授权、药物运输和经济援助。结论与专科药房团队的持续合作对于参与者迅速过渡到保险支付的治疗并克服障碍至关重要，而研究提供的为期两周的启动包则有助于在诊断点进行当天治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.