A research programme to model, establish and evaluate testing and treatment of hepatitis C infection in community pharmacy

Abstract

This thesis aims to present the case for establishing a routine service for testing and treatment of hepatitis C (HCV) for people prescribed opioid substitution therapy (OST) and attending community pharmacies. In order to support its contention, it reports on the methodological strategies, knowledge translation and evidence outcomes from the contributions of a series of published research studies. The studies were the outputs from a research fellowship provided by Gilead and from two research grants obtained from Gilead, the Scottish Government and Bristol Myers Squibb during the period 2013-2018. The studies were conceptualised, developed and interpreted through participatory and iterative research planning processes. The research drew on theories and constructs from many sources, but was especially reliant on the Medical Research Council’s Framework for the development and evaluation of complex interventions to improve public health. Its key generalisable findings are summarised as follows: -The identification of a large, but fragmented pool of knowledge indicating that the technology provided through innovation in medicines design and marketing can lead to a simplification of healthcare processes and therefore increase access for vulnerable and stigmatised populations -That the way healthcare is organised may be determined by inertia and the needs of health services, rather than by the effective deployment of resources to maximally impact on health gain -The implementation of innovative services in healthcare requires additional skills to those established and recognised as central to development of evidence-based healthcare. These include practical approaches to stakeholder management, resource deployment and contracting. The political context and business objectives of stakeholders may have greater weight in determining uptake of a service than evidence of population health gain. -That the real life healthcare environment can provide the context for healthcare research and evaluation and that the participation in research by stakeholders, service providers and patients can be part of the process of modernisation of heath care services. This thesis aims to establish the case that the programme of research presented has made an original and useful contribution to knowledge on design, implementation and evaluation of a community pharmacy service. It further aims to build the case that evidence generated in this way can inform and support policy development in the wider context, with a reappraisal of capability and capacity. Its most significant contributions have been: -Support for the delivery of the WHO strategic aim for the Elimination for Hepatitis C as a public health concern by 2034. -Providing supporting evidence and guiding the development of recommendations -Informing and supporting the development of Governments’ policy on elimination of hepatitis C as a public health concern