Point-of-Care Testing in Community Pharmacies: A Mixed-Methods Study on Users and Pharmacists’ Facilitators and Barriers

Background Point-of-care tests can contribute to earlier diagnosis and treatment of infectious diseases with the potential to prevent chronic stages. As part of the Fast-Track Cities initiative, a pilot was initiated in community pharmacies in Portugal. Aim To characterize the individuals using point-of-care screening tests for human immunodeficiency virus, hepatitis C and hepatitis B virus infections in community pharmacies, their behaviours and motivations to perform the tests, as well as understand the facilitators and barriers from the perspectives of pharmacists. Method A mixed-methods study was conducted. A survey was applied to test users in pharmacies between May and December 2019, and three focus groups were conducted with pharmacists involved in the initiative. Qualitative data were analysed according to thematic content analysis. Results A total of 210 questionnaires were collected. Point-of-care tests users were predominantly male, mean age of 35 years, the majority were foreign-born and had higher education level. Almost half of the users were first time tested and the main reason for screening was unprotected intercourse. Pharmacists identified speed, confidentiality, counselling provided to users, pharmacists’ initial training to perform the tests and trust in the pharmacist as facilitators of these tests. Stigma associated with infections, the procedure, logistical conditions and the referral process were considered as barriers. Conclusion Pharmacies are an effective screening site, with particular relevance for individuals who are first tested, heterosexuals and some migrants. Nevertheless, it is necessary to understand and reduce barriers and increase the support of specific groups.

Epidemiologicаl peculiаrities of hepatitis B virus infection in Hemodiаlysis pаtients from the Republic of Moldovа

Introduction. Hemodiаlysis pаtients аre аt higher risk of trаnsmitting virаl infections, including hepаtitis B virus (HBV) infection, due to the frequent need for blood trаnsfusions аnd the potential exposure to contаminаted diаlysis equipment. Mаteriаl аnd methods. The study was conducted on a risk group of 121 hemodiаlysis pаtients, аged between 18 аnd 70 yeаrs, the meаn аge being 48.1±13.1 yeаrs. Results. The prevalence of the serological mаrker of hepаtitis B virus (HBsАg) accounted for 7.4±2.4% (n=9) of cases and no аnti-HBs mаrker wаs detected in 47.7±5.3% of the hemodiаlysis pаtients investigаted. Mаles were positive for the HBsАg mаrker in 8.7±3.4% (n=6) of cases, whereas most patients being from the Central Аreа (13.8±6.5%). Conclusion. The serological prevalence of the hepatitis B virus infections markers, аs well аs the аssessment of the immune response in people undergoing hemodiаlysis treаtment might outline the bаsic monitoring and control tools in the development of specific аntiepidemic meаsures against this infection.

Efficacy of 104-week Telbivudine-based optimization strategy in patients with HBeAg-negative chronic hepatitis B virus infections

Background Evaluate the safety and efficacy of 104-week regimen of Telbivudine(LdT)-based optimization strategy for Chinese patients who have chronic hepatits B(CHB) with HBeAg-negative. Methods This multi-center, open-label, prospective study enrolled 108 HBeAg-negative CHB patients who received LdT (600 mg/day) for 24 weeks, Adefovir (ADV) was added if HBV DNA remained detectable at week 24, otherwise LdT was maintained to use until 104 weeks. HBV DNA, alanine amino transferase (ALT), hepatitis B surface antigen(HBsAg), creatinine kinase(CK), and estimated glomerular filtration rate (eGFR) were measured, safety was assessed. Results Eighty-eight patients (81%) had HBV-DNA undetectable at 24 weeks and maintained to receive LdT monotherapy until 104 weeks, whereas the other 20 patients had HBV-DNA detectable and ADV was used in combination. For all patients, 72% of patients reached ALT normalization at 24 weeks, which increased to 80% at 52 weeks and 104 weeks, respectively.. 81% of total patients had undetectable HBV-DNA at 24 weeks, 92% at 52 weeks, and 94% at 104 weeks. The HBsAg titre declined steadily from baseline to 104 weeks (3.62 vs. 2.98 log10 IU/mL, p < 0.05), and the eGFR increased steadily from baseline to 104 weeks (92.9 vs. 104.4 mL/min/1.73 m2, p < 0.05). Although 79 patients (73%) had at least one time of elevated CK, most of these patients had CK elevated in Grade 1/2. Conclusions LdT was well tolerated and effective, and 94% of patients achieved virological suppression after 104 weeks. Trial registration This study was registered in clinicaltrials.gov on January 31, 2012 and the ID No. was NCT01521975.