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/项目摘要 阿片类药物流行是美国的一项重大公共卫生危机，导致大量发病率和 与阿片类药物使用障碍和注射用药的后果有关的死亡率，即丙型肝炎病毒 (丙型肝炎病毒)、艾滋病毒和过量用药。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 这可以改善和维持注射吸毒者的生活(PWID)。目前有一些药物可以 可用于1)治愈丙型肝炎病毒(直接作用抗病毒药物或DAA)，2)预防艾滋病毒感染(暴露前 预防[PrEP])，以及3)治疗/预防过量用药(纳洛酮和药物治疗)。此外， 消除丙型肝炎病毒的机会前所未有，丙型肝炎病毒是一种通过注射毒品传播的疾病。 然而，实现消除的目标将需要更好的系统，使PWID能够获得 治疗丙型肝炎的药物，以及预防过量用药和艾滋病毒的药物。药剂师和 社区药房项目可能是解决这一问题的创新方案。协作式药物治疗 协议(CDTA)允许药剂师有权自主执行测试和处方，并 配药。我们建议使用这种R34机制来开发和试点测试一种新型的健康 服务交付模式，即向以下人员提供DAA和药物的社区药房计划 预防丙型肝炎患者服药过量及HIV感染。对于目标1，我们将进行定性访谈， PWID与丙型肝炎病毒和其他主要社区利益攸关方合作，以告知社区的发展- 药房计划，以扩大获得治疗丙型肝炎病毒和预防过量用药和艾滋病毒的药物。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。此应用程序是 根据资金公告PA-18-774提交(“试点保健服务和经济研究 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的试点测试 优化药物使用障碍相关服务以及共病医疗服务的准入利用 条件。拟议的研究利用了许多与当地社区现有的合作伙伴关系 并将导致未来的多地点有效性研究，该研究将利用现有的社区- 以药房为基础，努力通过扩大救命途径来改善吸毒者的健康 药物。

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.