Testing and Treating Hepatitis C in Community Pharmacies (SuperDOT-C)
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.
研究概览
详细说明
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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-
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Aberdeen、英国、AB25 2ZN
- NHS Grampian
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Dundee、英国、DD1 9SY
- NHS Tayside
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Glasgow、英国、G$ 0SF
- NHS Greater Glasgow and Clyde
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-
参与标准
资格标准
适合学习的年龄
- 孩子
- 成人
- 年长者
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的?
设计细节
- 主要用途:卫生服务研究
- 分配:随机化
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的:Pharmacist Led
This arm involved subjects following pathway of care and treatment delivery delivered by community pharmacists
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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
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实验性的:Nurse Led
This arm involved subjects following the conventional pathway of care and treatment delivery delivered by specialist secondary care nurses
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Trial of administering established, licensed treatments by the conventional clinical care pathway, ie Specialist nurses
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
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
大体时间:12 week SVR, (12 weeks post completion of HCV treatment)
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Blood test result; PCR - based measurement of levels of hepatitis C virus.
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12 week SVR, (12 weeks post completion of HCV treatment)
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Cost effectiveness of the pharmacist pathway as compared with the conventional care pathway
大体时间:Span of study ie 24 months
|
Health economics analysis
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Span of study ie 24 months
|
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To determine whether the Pharmacist-led pathway compared with the Conventional Pathway leads to more people on OST being tested and initiating treatment
大体时间:Span of study ie 24 months
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Comparison of rate of HCV testing rates in pharmacist pathway compared with current pathway
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Span of study ie 24 months
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To explore whether adherence and persistence to HCV therapy in the pharmacy setting is at least similar to that in the Conventional pathway
大体时间:Span of study ie 24 months
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Comparison of compliance rates of antiviral medications between pharmacist and conventional pathway.
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Span of study ie 24 months
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To compare the acceptability of the Pharmacist-led pathway versus the conventional treatment pathway for OST clients
大体时间:Span of study ie 24 months
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Compare the acceptability of the pharmacist pathway as compare to conventional pathway of care
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Span of study ie 24 months
|
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To measure re-infection rate at 1 year after end of treatment in patients with SVR
大体时间:Span of study ie 24 months
|
Comparison of the rate of reinfections with HCV between pharmacist and conventional pathways
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Span of study ie 24 months
|
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To compare the number of patients who drop out of the study between the two pathways
大体时间:Span of study ie 24 months
|
Comparison of subject drop out rates between pharmacist and conventional pathways
|
Span of study ie 24 months
|
合作者和调查者
调查人员
- 首席研究员:John F Dillon, MD、University of Dundee
出版物和有用的链接
一般刊物
- Radley A, de Bruin M, Inglis SK, Donnan PT, Hapca A, Barclay ST, Fraser A, Dillon JF. Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial. Lancet Gastroenterol Hepatol. 2020 Sep;5(9):809-818. doi: 10.1016/S2468-1253(20)30120-5. Epub 2020 Jun 8.
- Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open. 2019 Sep 24;9(9):e029538. doi: 10.1136/bmjopen-2019-029538.
- Radley A, de Bruin M, Inglis SK, Donnan PT, Dillon JF. Clinical effectiveness of pharmacy-led versus conventionally delivered antiviral treatment for hepatitis C in patients receiving opioid substitution therapy: a study protocol for a pragmatic cluster randomised trial. BMJ Open. 2018 Dec 14;8(12):e021443. doi: 10.1136/bmjopen-2017-021443.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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