Viral hepatitis testing and treatment in community pharmacies:a systematic review and meta-analysis

Background: The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods: Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings: Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%–23.0%; heterogeneity I 2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%–40.6%; heterogeneity I 2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%–6.5%; heterogeneity I 2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%–99.9%; heterogeneity I 2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%–70.1%; heterogeneity I 2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%–94.3%; heterogeneity I 2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation: These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding: None.</p

Categories of CSDs.

This mixed-methods study focuses on the evidence of the health impacts of climate change on populations affected by humanitarian crises, presented from the perspective of Médecins Sans Frontières (MSF)–the world’s largest emergency humanitarian medical organisation. The Sixth Assessment Report from the Intergovernmental Panel on Climate Change (IPCC) was used as the basis of a narrative review, with evidence gaps highlighted and additional literature identified relevant to climate-sensitive diseases and health problems under-reported in–or absent from–the latest IPCC report. An internal survey of MSF headquarters staff was also undertaken to evaluate the perceived frequency and severity of such problems in settings where MSF works. The findings of the survey demonstrate some discrepancies between the health problems that appear most prominently in the IPCC Sixth Assessment Report and those that are most relevant to humanitarian settings. These findings should be used to guide the direction of future research, evidence-based adaptations and mitigation efforts to avoid the worst impacts of climate change on the health of the world’s most vulnerable populations.</div

CSDs included in study.

This mixed-methods study focuses on the evidence of the health impacts of climate change on populations affected by humanitarian crises, presented from the perspective of Médecins Sans Frontières (MSF)–the world’s largest emergency humanitarian medical organisation. The Sixth Assessment Report from the Intergovernmental Panel on Climate Change (IPCC) was used as the basis of a narrative review, with evidence gaps highlighted and additional literature identified relevant to climate-sensitive diseases and health problems under-reported in–or absent from–the latest IPCC report. An internal survey of MSF headquarters staff was also undertaken to evaluate the perceived frequency and severity of such problems in settings where MSF works. The findings of the survey demonstrate some discrepancies between the health problems that appear most prominently in the IPCC Sixth Assessment Report and those that are most relevant to humanitarian settings. These findings should be used to guide the direction of future research, evidence-based adaptations and mitigation efforts to avoid the worst impacts of climate change on the health of the world’s most vulnerable populations.</div

Percentage of survey respondents who answered ‘I don’t know’ when asked to estimate the frequency and severity of each CSD in MSF settings.

Percentage of survey respondents who answered ‘I don’t know’ when asked to estimate the frequency and severity of each CSD in MSF settings.</p

Perceived frequency and severity of CSDs in MSF settings.

Perceived frequency and severity of CSDs in MSF settings.</p

Perceived overall relevance of CSDs to MSF (in terms of product of estimated frequency and severity).

Perceived overall relevance of CSDs to MSF (in terms of product of estimated frequency and severity).</p