Pilot Study of a Community-Pharmacy Model to Expand Access to Medications to Treat and Prevent Hepatitis C, Opioid Use Disorders, Overdose and HIV Among Persons Who Inject Drugs

摘要/项目总结 阿片类药物流行病是美国的一个重大公共卫生危机，导致大量发病率， 与类阿片使用障碍和注射吸毒后果有关的死亡率，即丙型肝炎病毒 (HCV)艾滋病和过量服用然而，我们正处于一个独特的历史时刻，因为我们拥有有效的药物， 可以改善和维持注射毒品者的生活（PWID）。目前有一些药物， 可用于1）治愈HCV（直接作用的抗病毒药物或DAA），2）预防HIV感染（暴露前 预防[PrEP]）和3）治疗/预防过量（纳洛酮和治疗OUD的药物）。此外，委员会认为， 消除丙型肝炎病毒是一种通过注射毒品传播的疾病，这是一个前所未有的机会。 然而，实现消除目标将需要更好的系统，使残疾人能够获得 治疗丙型肝炎的药物，以及防止过量和艾滋病毒的药物。药剂师和 社区药房计划可能是解决这一问题的创新方案。协同药物治疗 协议（CDTA）允许药剂师有权自主进行测试和处方， 分发药物我们建议使用这种R34机制来开发和试点测试一种新的健康 服务提供模式，即社区药房计划，为 在感染HCV的PWID中预防药物过量和HIV。对于目标#1，我们将进行定性访谈， PWID与HCV和其他关键社区利益相关者合作，以告知社区的发展- 该计划旨在扩大获得治疗HCV和预防过量用药和艾滋病毒的药物的机会。对于目标#2， 我们将在西雅图的一家当地药房试行和评估社区药房计划。本申请是 根据资金公告PA-18 - 774（"试点卫生服务和经济研究， 药物、酒精和烟草滥用的治疗"），其中包括对保健服务干预措施进行试点测试 优化药物使用障碍相关服务的获取利用，以及共病医疗服务， 条件拟议的研究利用了一些现有的社区伙伴关系， 利益相关者，并将导致未来的多站点的有效性研究，将利用现有的社区， 为了通过扩大获得拯救生命的机会来改善吸毒者的健康， 药物治疗

ABSTRACT/PROJECT SUMMARY The opioid epidemic is a major public health crisis in the United States, leading to substantial morbidity and mortality related to the consequences of opioid use disorders and injection drug use, namely hepatitis C virus (HCV), HIV, and overdose. Yet, we are at a unique historical moment, as we possess effective medications that can improve and sustain the lives of people who inject drugs (PWID). Currently there are medications that can be prescribed to 1) cure HCV (directly-acting antivirals or DAAs), 2) prevent HIV infection (Pre-exposure Prophylaxis [PrEP]), and 3) treat/prevent overdose (naloxone and medications to treat OUD). Furthermore, there is an unprecedented opportunity to eliminate HCV, a disease that is transmitted through injecting drugs. However, achieving the goals of elimination will require better systems for allowing PWID access to medications to cure hepatitis C, as well as medications to prevent overdose and HIV. Pharmacists and community-pharmacy programs may be an innovative solution for this problem. Collaborative Drug Therapy Agreements (CDTAs) allow pharmacists to have authority to autonomously perform testing and prescribing and dispensing medications. We propose to use this R34 mechanism to develop and pilot test a novel health service delivery model, namely a community-pharmacy program for providing DAAs and medications to prevent overdose and HIV among PWID with HCV. For Aim #1, we will conduct qualitative interviews with PWID with HCV and other key community stakeholders in order to inform the development of a community- pharmacy program to expand access to medications to treat HCV and prevent overdose and HIV. For Aim #2, we will pilot and evaluate the community-pharmacy program at a local pharmacy in Seattle. This application is submitted under the funding announcement PA-18-774 (“Pilot Health Services and Economic Research on the Treatment of Drug, Alcohol, and Tobacco Abuse”), which includes pilot testing of health service interventions that optimize access utilization of drug use disorder related services, as well as services for comorbid medical conditions. The proposed research leverages a number of existing community partnerships with local stakeholders and would lead to a future multi-site effectiveness study that would utilize existing community- based pharmacies in order to work toward improving drug users' health by expanding access to life-saving medications.