IntroductionHepatitis C virus (HCV) predominantly affects vulnerable and disenfranchised individuals, including people who use drugs (PWUD) and people who are homeless (PWAH);our prior work shows only 5% attend hospital appointments for HCV management.MethodsThe medication homecare delivery model has been used successfully within our Sussex Hepatology Operational Delivery Network (ODN) but relies on clients having an address and/or the ability to sign for deliveries;the latter also proves difficult in hostels where hostel staff are reluctant to be involved with medication deliveries. On-line shopping companies have adopted ‘lock-box’ delivery systems for customers who are unable to sign for a delivery, storing the parcel in a secure lock-box thus enabling later convenient collection. We adopted this strategy to ensure safe provision of HCV medications for difficult-to-engage individuals.Lock-boxes were installed in two centrally located Brighton hostels that were participating in our on-going community-based studies;a day hostel (which is accessed by PWUD and PWAH so providing a convenient collection point for these clients) and a residential hostel (which houses PWUD). Lock-boxes at the residential hostel enables micro-elimination within the hostel. Access to lock-boxes was via client-specific key-codes with override facilities available for the pilot leads.Once clients were assessed to be eligible for HCV treatment at the weekly multi-disciplinary ODN meeting, the pharmacy team prescribed and managed delivery to the lock-boxes. Prescribing was enabled via non-medical prescribing pharmacists, cost effective dispensing was guaranteed using the outsourced outpatient pharmacy, medication was dispensed in weekly or monthly blister-packs (depending on client requirements via HCV nurse assessment) and deliveries completed monthly. Usage was monitored on a continuous basis when refilling the lock-boxes and via close relationship with the treating HCV nurse.ResultsThis pilot ran from January 2020 to April 2020. Seven clients were entered into the pilot. Two PWUD/PWAH and four hostel-resident clients successfully completed HCV treatment. One client decided to disengage from treatment unrelated to the lock-box. The feedback has been overwhelmingly positive from both clients and service providers. The pilot was reliant on one specialised ODN pharmacist. Unfortunately, due to COVID-19 this pilot was put on hold but aims to continue once COVID-19 risks are manageable.ConclusionsPreliminary results from this innovative pilot are favourable as regards improving access to HCV treatment amongst a difficult-to-engage cohort and merits further assessment.
Can the online shopping model ‘lock-box delivery’ improve Hepatitis C treatment access amongst vulnerable adults?