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The possibility of clients reacting dismissively and of unsettling clients were viewed as the main barriers preventing better screening within these populations.
A team, led by Dominik Stampfli, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, ETH Zurich, assessed the feasibility and pharmacist acceptance of HCV rapid antibody saliva testing in community pharmacies.
While HCV infections can often go undetected until sequelae develop, screening programs in vulnerable populations in community pharmacies could help prevent further undetected infections.
Due to the low prevalence of HCV in the general Swiss population, the Swiss Federal Office of Public Health has decided against a national population screening to identify unnoticed HCV infections. Rather, specific vulnerable populations should be targeted for testing.”
Some of the risk factors for HCV occurrence found in recent studies specifically looking at Switzerland included intravenous drug users, birth cohorts 1955–1974, recipients of blood, blood products or organs before 1992, persons immigrated from HCV endemic regions, and men having sex with men.”
In the study, the investigators developed a structured pharmaceutical care intervention that included addressing, informing, and screening clients, as well as referral and reporting to subsequent health care providers.
Each pharmacy based in the French-, German- and Italian-speaking parts of Switzerland were trained to provide services to local vulnerable populations.
The pharmacists were trained through an online lecture on the pathology, incidence rates, and vulnerable populations. They then watched a webinar on the developed screening intervention, including the use of the saliva test and participated in an on-site training in the pharmacy focusing on the individual strategy and communication for recruiting clients from 2 vulnerable populations, as defined by the Swiss Federal Office of Public Health.
Each pharmacy decided which vulnerable populations to address based on local circumstances.
The investigators collected data on client recruitment, feasibility, and acceptability.
A total of 36 pharmacies were initially recruited, 25 of which started the pilot. These 25 pharmacies approached 435 clients, 33% (n = 145) of which were interested in screening.
The results show 8 of the rapid antibody tests were positive with a prevalence rate of 5.5%.
Facilities were able to offer a free rapid test (73%), followed by training prior to the project (67%) and having a new service to offer (67%) and the possibility of clients reacting dismissively (53%) and of unsettling clients (47%) were viewed as the main barriers.
“This pilot demonstrated the general feasibility of an HCV screening service with rapid antibody saliva testing in Swiss community pharmacies, which achieved a higher prevalence rate than national estimates,” the authors wrote. “With appropriate communication training and remuneration, Swiss community pharmacies could be an important partner in implementing HCV elimination strategies.”
Stämpfli, D., Imfeld-Isenegger, T.L., Hersberger, K.E. et al. Hepatitis C virus screening in community pharmacies: results on feasibility from a Swiss pilot. BMC Infect Dis 23, 384 (2023). https://doi.org/10.1186/s12879-023-08362-1