Background: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Methods: Four pharmacies who work with PWUD and provide opioid agonist therapy were trained to provide consent and perform point-of-care HCV antibody screening. They were supported by study nurse to link to HCV RNA testing when antibody positive patients were identified, with HCV treatment offered to RNA positive participants. Qualitative interviews were conducted with five pharmacy staff to explore experiences and feasibility of pharmacists in HCV care cascade. Results: Pharmacy staff completed 200 HCV OraQuick tests between October 2020 and June 2022: 65 HCV antibody positive, 29 HCV RNA negative (25 previously treated and 4 self-cleared). Of the 26 RNA positive participants, one is awaiting treatment, 25 people have started treatment, 22 achieving SVR. Although the onset of the COVID-19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Conclusions: This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.

In the last decade, hepatitis C virus (HCV) has become a curable chronic viral infection, with excellent treatment and streamlined diagnostic testing. Canada and many other countries have adopted national elimination targets; however, reaching these goals will require changes in the way care is provided. Standard of care HCV treatment is all-oral daily medication for 8 or 12 weeks and all provinces in Canada have mechanisms for public coverage. Unfortunately, vertical transmission continues to be the predominant reason for paediatric infection, but if diagnosed, children can be treated as young as 3 years old. Early paediatric diagnosis and cure are of the utmost importance to prevent complications such as adverse mental health outcomes and advanced liver disease early in life. One major barrier to paediatric diagnosis and cure is poor antibody screening uptake, as low as 23% by 18 months among children born to positive persons. In the United States, a landmark study showed a temporal decrease in screening rates from 91% at 2 months to 59% at 18 months. As such, the American Association for Study of the Liver/Infectious Disease Society of America, and very recently, the Centres for Disease Control and Prevention, now recommend screening by all children born to positive person for HCV RNA at 2-6 months of age. While antibody testing could still be completed at 18 months to determine serostatus, understanding if a child has active infection in infancy supports early linkage to care and decreases paediatric loss to follow-up.