Impact of a pharmacist-led hepatitis C clinic on hepatitis A and B vaccination rates and treatment outcomes: A retrospective cohort study.

Abstract

Hepatitis C virus (HCV) affects approximately 2.4 million people in the United States, with Kentucky having one of the highest HCV infection rates. The Centers for Disease Control and Prevention (CDC) recommend that all patients diagnosed with HCV be screened and vaccinated as appropriate for hepatitis A virus (HAV) and hepatitis B virus (HBV). Despite these long-standing recommendations, vaccination rates remain below target goals. To evaluate the impact of a pharmacist-led Medication Management Clinic (MMC) on HAV and HBV vaccination rates and other treatment outcomes in patients diagnosed with HCV compared with a traditional care model. This retrospective cohort study compared patients diagnosed with HCV treated through a pharmacist-led MMC between August 1, 2022, and February 28, 2024, with those treated through traditional care between August 1, 2016, and February 28, 2018. Primary outcomes included HAV and HBV vaccination initiation rates among eligible patients. Secondary outcomes included screening rates for HAV and HBV, HCV treatment completion, sustained virologic response (SVR), and specialty pharmacy prescription retention. Logistic regression was performed to assess the relationship between vaccination rates and type of care received (traditional care vs MMC), adjusting for baseline demographic and clinical factors, including, age, sex, HCV genotype, and fibrosis stage. Adjusted odds ratios (aORs) with 95% CIs were calculated for HAV and HBV initiation. The study included 330 MMC patients and 250 traditional care patients. Among eligible patients, HAV vaccination rates were higher in the MMC group (33.3% vs 22.6%, <i>P</i> = 0.02; unadjusted OR = 1.71, 95% CI = 1.11-2.65). After adjusting for age, sex, genotype, and fibrosis stage, patients in the traditional care group were less likely to receive HAV compared with patients in the MMC group (aOR = 0.569, 95% CI = 0.362-0.893; <i>P</i> = 0.014). Similarly, HBV vaccination rates were higher in the MMC group (36.6% vs 23.7%, <i>P</i> = 0.01; unadjusted OR = 1.84, 95% CI = 1.15-2.94). In the adjusted analysis, patients in the MMC group were more likely to receive HBV compared with patients in the traditional care group (aOR = 1.85, 95% CI = 1.14-3.00; <i>P</i> = 0.013). Additionally, older age (OR = 1.03 per year, 95% CI = 1.01-1.05; <i>P</i> = 0.008) and female sex (OR = 2.29, 95% CI = 1.39-3.754; <i>P</i> = 0.001) were independent predictors of HBV vaccination. The MMC group also achieved higher screening rates for HAV (97.6% vs 76.4%, <i>P</i> < 0.001) and HBV (96.1% vs 28.8%, <i>P</i> < 0.001) and a greater proportion initiated HCV treatment (95.8% vs 24.4%, <i>P</i> < 0.001), although these treatment initiation differences may be partly attributable to changes in national guidelines and payor restrictions between study periods. A trend toward improved SVR rates was also observed (80.6% vs 68.9%, <i>P</i> = 0.06). The specialty pharmacy prescription retention rate in the MMC group was 81.0%. In a setting where HAV and HBV vaccination guidelines remained consistent over time, the pharmacist-led MMC model was associated with higher vaccination and screening rates compared with the traditional care model, and these associations remained robust after adjustment for age, sex, genotype, and fibrosis stage. The model may have contributed to increased treatment initiation during a period of evolving HCV treatment guidelines. These findings support the potential value of pharmacist-led collaborative care agreements in delivering comprehensive HCV management during a period of evolving HCV treatment guidelines. These findings support the potential value of pharmacist-led collaborative care agreements in delivering comprehensive HCV management.