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.

Public Health Relevance

Persons who inject drugs (PWID) face barriers to accessing efficacious and potentially life-saving medications. The purpose of the research is to develop and pilot a community-pharmacy based model of care for PWID that can offer treatment for hepatitis C virus (HCV), in addition to medications to prevent overdose and HIV. The proposed research would lead to a future multi-site effectiveness study that will utilize existing community- based pharmacies to expand access to relevant medications for PWID, in order to reduce health disparities in this group and reach the World Health Organization's goal to eliminate HCV by 2030.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Planning Grant (R34)
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Community-Level Health Promotion Study Section (CLHP)
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Flournoy Floyd, Minnjuan Wyncephel
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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