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Testing and Treating Hepatitis C in Community Pharmacies (SuperDOT-C)

29. august 2019 oppdatert av: University of Dundee

A Cluster Randomised Trial of Pharmacy Led HCV Therapy Versus Conventional Treatment Pathways for HCV Positive Patients Receiving Daily OST in Pharmacies in Health Boards Within NHS Scotland

Hepatitis C Virus, (HCV), infection is a major health concern in the UK with up to 0.7% of the population infected. At best, 25% of those infected will clear the infection spontaneously, though for those who develop a chronic infection, they may go onto to develop liver cirrhosis or liver cancers.

The standard of care within the NHS is that patients with a history of intravenous drug use or those currently on methadone are at high risk of having HCV infection and should be offered HCV testing. Once diagnosed they can be referred to nurse led treatment pathways. Less than 10% of the methadone users are even tested for HCV and of them fewer than 20% go onto treatment regimens that successfully clear the infection despite regular interactions with heath care staff.

Pharmacists who have daily interactions with patients receiving methadone are ideally placed to deliver anti HCV therapy as they have daily contact with this client group and are well placed to advise on the drug therapy.

The SuperDOT C study will examine the impact of pharmacy led Directly Observed Therapy (DOT) for HCV treatment in patients attending Community Pharmacies in participating Health Boards within NHS Scotland. The impact of this approach will be compared with those referred to standard care pathways on how well participants clear their HCV infection.

Studieoversikt

Status

Fullført

Forhold

Detaljert beskrivelse

The SuperDOT-C study will evaluate a new pathway of care for patients on OST who are already receiving OST therapy on a daily basis from a pharmacist. Newer therapies for HCV have recently become much simpler to initiate and supervise with much improved effectiveness and as described below it is now proposed to extend the role of community pharmacists into initiating HCV therapy alongside the existing OST The SuperDOT-C study will utilise this existing environment and relationship to smooth the pathway into HCV therapy with co-administration of OST alongside the anti-HCV therapy under the supervision of the pharmacist compared with the established pathway of referral to another site and treatment with a nurse led ant-HCV treatment program. This new pathway may have positive effects on the movement towards HCV cure at multiple levels. The planned pathway is different to current care at each point, from testing and diagnosis through adherence to cure. In the planned pathway, the patient interacts with the pharmacist on a daily basis, as compared to intermittent interaction with a secondary care team member. The result being that the patient has a shorter care pathway, with less travelling and better access to anti-HCV treatment. The daily interaction with the pharmacy provides opportunities to assess and support the patient, provide sound advice and care, with the added benefit of being able to directly observe treatment, (DOT), thus potentially improving adherence.

Studietype

Intervensjonell

Registrering (Faktiske)

356

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

      • Aberdeen, Storbritannia, AB25 2ZN
        • NHS Grampian
      • Dundee, Storbritannia, DD1 9SY
        • NHS Tayside
      • Glasgow, Storbritannia, G$ 0SF
        • NHS Greater Glasgow and Clyde

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Barn
  • Voksen
  • Eldre voksen

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • HCV PCR positive,
  • Stable OST dose for greater than 12 weeks prior to study enrolment

Exclusion Criteria:

  • Evidence of current or previous decompensated liver disease,
  • Currently receiving HCV eradication treatment
  • HIV infection,
  • HBsAg positive with detectable HBV DNA,
  • Pregnancy
  • Cirrhosis or high fibrosis score
  • Genotype deemed unsuitable for treatment with available study drugs
  • Unable or unwilling to provide informed consent

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Helsetjenesteforskning
  • Tildeling: Randomisert
  • Intervensjonsmodell: Enkeltgruppeoppdrag
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: Pharmacist Led
This arm involved subjects following pathway of care and treatment delivery delivered by community pharmacists
Trial of administering established, licensed treatments by a novel pathway, ie Community Pharmacists, which is hypothesized to improve treatment and retention in treatment of difficult to engage subjects
Eksperimentell: Nurse Led
This arm involved subjects following the conventional pathway of care and treatment delivery delivered by specialist secondary care nurses
Trial of administering established, licensed treatments by the conventional clinical care pathway, ie Specialist nurses

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Rate of Sustained Viral Response at 12 weeks, (SVR12), in pharmacy pathway compared with that of the current treatment pathway 12 weeks after completion of HCV therapy
Tidsramme: 12 week SVR, (12 weeks post completion of HCV treatment)
Blood test result; PCR - based measurement of levels of hepatitis C virus.
12 week SVR, (12 weeks post completion of HCV treatment)

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Cost effectiveness of the pharmacist pathway as compared with the conventional care pathway
Tidsramme: Span of study ie 24 months
Health economics analysis
Span of study ie 24 months
To determine whether the Pharmacist-led pathway compared with the Conventional Pathway leads to more people on OST being tested and initiating treatment
Tidsramme: Span of study ie 24 months
Comparison of rate of HCV testing rates in pharmacist pathway compared with current pathway
Span of study ie 24 months
To explore whether adherence and persistence to HCV therapy in the pharmacy setting is at least similar to that in the Conventional pathway
Tidsramme: Span of study ie 24 months
Comparison of compliance rates of antiviral medications between pharmacist and conventional pathway.
Span of study ie 24 months
To compare the acceptability of the Pharmacist-led pathway versus the conventional treatment pathway for OST clients
Tidsramme: Span of study ie 24 months
Compare the acceptability of the pharmacist pathway as compare to conventional pathway of care
Span of study ie 24 months
To measure re-infection rate at 1 year after end of treatment in patients with SVR
Tidsramme: Span of study ie 24 months
Comparison of the rate of reinfections with HCV between pharmacist and conventional pathways
Span of study ie 24 months
To compare the number of patients who drop out of the study between the two pathways
Tidsramme: Span of study ie 24 months
Comparison of subject drop out rates between pharmacist and conventional pathways
Span of study ie 24 months

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Etterforskere

  • Hovedetterforsker: John F Dillon, MD, University of Dundee

Publikasjoner og nyttige lenker

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Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

1. desember 2016

Primær fullføring (Faktiske)

1. januar 2019

Studiet fullført (Faktiske)

1. mars 2019

Datoer for studieregistrering

Først innsendt

4. mars 2016

Først innsendt som oppfylte QC-kriteriene

9. mars 2016

Først lagt ut (Anslag)

11. mars 2016

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

30. august 2019

Siste oppdatering sendt inn som oppfylte QC-kriteriene

29. august 2019

Sist bekreftet

1. august 2019

Mer informasjon

Begreper knyttet til denne studien

Plan for individuelle deltakerdata (IPD)

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UBESLUTTE

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