A STUDY into how to test and treat methadone users for Hepatitis C in pharmacies could see the scheme rolled out to Glasgow.

The award-winning Scotland-led study found that pharmacy-based testing by nurses followed by the delivery of antivirals on site was associated with much higher rates of detection and cure. 

The findings could provide a blueprint for higher-income countries working towards the World Health Organisation’s goal of eliminating viral hepatitis as a public health threat by 2030. 

The trial was carried out at 40 pharmacies – 12 in Tayside, 14 in Wales and 14 in Australia – which were divided evenly into intervention and control arms to compare outcomes. 

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The intervention approach is already used routinely for Hep C across Tayside, but work is now under way to evaluate how cost-effective it would be to scale up nationally. 

Hepatitis C is inflammation of the liver caused by a blood-borne virus commonly transmitted via injection drug use, meaning that recovering heroin addicts are at particularly high risk. 

Left untreated, it causes liver cirrhosis and cancer.

However, the antiviral drugs now available can cure well over 90 per cent of cases. 

The Scottish Government says Scotland is on track to achieve the elimination target for Hep C in 2024, although the most recent data estimated that around half of cases remained undiagnosed. 

“We need to treat around 2,500 people by 2024, so there’s still quite a lot of work to do,” said Dr Christopher Byrne, an expert in liver disease who co-led the study at Dundee University with Professor John Dillon.

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The control group pharmacies continued with conventional approaches where methadone users were signposted to GP surgeries, needle exchanges or outreach clinics where Hep C testing is available. 

Blood samples would then be sent off to centralised laboratories, with results returned in around two or three days. 

In the intervention group, nurses were on site with GeneDrive diagnostic devices which can provide a result in just one-and-a-half hours. 

People coming to the pharmacy for methadone and other opioid-substitutes were invited to give a blood sample from which plasma could be extracted to test for infection. 

Dr Byrne said: “People would get tested in the morning and could come back in the afternoon for their results, because the nurse would stay on site.

“If someone tested positive they could start treatment the same day. The nurse would give them the results, fill out the paperwork for treatment, the medication would then be supplied by the trial team to the pharmacy, and the pharmacist dispensed it with their methadone for around eight weeks. 

“Everything was all done on site, from diagnosis and consultation through to treatment.”

The results were stark. 

Among the 648 participants in the control group, only 17 (2.6%) went on to be tested. 

That compared to 144 (19%) of the 762 participants visiting the intervention pharmacies. 

In the control group, six people tested positive, five received antiviral treatment, and follow-up testing at 12 weeks showed that two had been cured. 

In the intervention group, 23 people tested positive, 22 were prescribed antiviral drugs, and 18 were cured. 

Dr Byrne said removing “bottlenecks” in the care pathway by bringing Hep C testing and treatment “into venues frequently used by people who use drugs” achieved much higher success rates. 

He said: “If you were in the intervention arm, you were 16 or 17 times more likely to actually receive a test and 8.5 times more likely to get a cure. 

“The more steps there are – the more people have to move to other clinical sites, or somewhere out of area, to get from test to treatment – the less likely you are to keep them engaged.”

Figures released last year from Police Scotland showed there had been one drug death a day recorded in Greater Glasgow in the first nine months of 2021.

Greater Glasgow and Clyde routinely has the highest rate of new hepatitis C cases in Scotland. 

In 2018, 32% of new hepatitis C infections were in Glasgow, compared to the next highest rate of 17% of new infections in Lothian.