Royal Pharmaceutical Society

Treating patients with blood-borne viruses in the community

by Paul John, All Wales community lead pharmacist for blood-borne viruses

I’ve always been passionate about helping those in need. Earlier in my career whilst working in community pharmacy I particularly enjoyed supporting those on substance misuse pathways. This evolved into a hepatology and blood-borne virus secondary care role with emphasis on curing hepatitis C (HCV). My current role as All Wales community lead pharmacist for blood-borne viruses – involves identifying and treating patients with blood-borne viruses (BBV) such as hepatitis and HIV in the community.

I’ve been proud to be part of the successful Hepatitis C national campaign with the team being recognised recently for a BMJ clinical leadership award. Since 2014 we have treated over 2500 patients in Wales, saving in excess of £29 million through procurement, reducing progressive liver disease and halving the need for liver transplants with hepatitis C being the primary disease.

Our target is to identify the remaining 12,000 patients in Wales required to eliminate HCV in Wales. The hepatitis C virus is very simple to detect and can be cured with an oral course of once daily antivirals. Our biggest challenge is identifying those infected individuals. Many of our patients are asymptomatic with acutely distorted liver function tests. Unless detected with specific antibody and PCR tests, many can silently progress to scarring of the liver (cirrhosis) or end stage liver disease (ESLD).

What I do

My role in this important work is varied and no two days are the same. Although I’m based in the community my role takes me to out-reach clinics, hospitals, substance misuse agencies, prisons and general practice. I also liaise with research projects and the pharmaceutical industry to simplify identification pathways with the future aim of test and treat in a single day.

Part of my role is to educate, teach and support community pharmacy staff to provide the service. I understand that this is a new clinical area for many and it’s so satisfying to see them grow in confidence as they are offering such a great service. To support our training programme, we have worked with Health Education and Improvement Wales to produce a learning module that reinforces the learning. I also always emphasise to staff we are always accessible if they need us and want to ask further questions.

The pandemic has had an impact on this work, but we have modified our approach to sustain clinics. We have offered virtual ‘attend anywhere’ clinics, allowing for discussions on blood results and to support ongoing treatment. During the consultation we can also determine if patients need surveillance for cancer and prescribe the necessary treatment for the viral infection.

Working within a multidisciplinary team has continued to be important too and I continue to learn so much from colleagues from different disciplines. I hope that I can spread this learning into community pharmacy practice in order to increase accessibility of patients and treating BBV.

Looking to the future

We now have an enhanced service for pharmacies in Wales which is a great development.  Support can be offered by both pharmacists and pharmacy technicians for patients who suspect they have been exposed to a blood borne viruses such hepatitis C, hepatitis B and HIV. The test is traditionally offered through a finger prick test, however new technology is emerging in this field.

I was pleased to see community pharmacy Hepatitis C Antibody Testing Service introduced in England as a new service. It will be interesting to monitor their progress and work together to achieve the WHO global eradication aim.

There is no doubt that community pharmacy will continue to play an increasingly important role in this work. I look forward to further opportunities for community pharmacy to help lead us to our target of eliminating HCV in Wales.

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