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The Pharmacist, Physician, and Patient Navigator Collaborative Care Model (PPP-CCM) for hepatitis C treatment brought treatment to community settings for people who inject drugs. The PPP-CM was led by pharmacists with the support of physicians and a patient navigator. There were 40 people enrolled in the pilot study and 38 were successfully linked to a pharmacist for initial hepatitis C treatment evaluation. Of those, 21 (55%) received direct-acting antiviral (DAA) medication, and of those 16 (76%) completed treatment. Of the 11 people with data on sustained virologic response at 12 weeks post-treatment (SVR12), 10 (91%) achieved cure.1

Program description1,2

The PPP-CCM used pharmacists to deliver hepatitis C care onsite at community-based organizations that serve people who inject drugs. The care team included two community pharmacists, two physicians (one specialist trained in infectious diseases and one physician trained in primary care and addiction medicine with experience treating people with hepatitis C) and a patient navigator. Participants were recruited using posters at and referrals from the following community-based organizations: an organization focused on hepatitis education that also provided a needle and syringe program; an opioid treatment program; and several emergency housing units. These organizations are also where pharmacists met with participants and provided treatment. Participants were adults who were injecting drugs at the time of the study (within the previous 90 days), had a chronic hepatitis C infection, were not currently on treatment for hepatitis C and had not previously been treated for hepatitis C using DAAs.

Pharmacists were able to provide the full spectrum of hepatitis C care including diagnosis, counselling and education, workup (e.g., laboratory tests, fibrosis staging), treatment and post-treatment assessment for SVR12. Pharmacists treated all people who did not have medically complex needs (e.g., did not have HIV or advanced cirrhosis). A collaborative practice agreement between the pharmacists and physicians detailed care protocols that were jointly developed by the pharmacists and physicians on the basis of established clinical guidelines. 

Participants were linked to a pharmacist by a patient navigator for an initial evaluation. In the initial evaluation, a pharmacist took a comprehensive history and conducted an assessment, including laboratory tests required to start hepatitis C treatment. The pharmacists received online hepatitis C training and were also trained and licensed as phlebotomists. Pharmacists, or other staff trained in phlebotomy, performed blood draws for the tests necessary to start hepatitis C treatment (training multiple people to do blood draws was part of a strategy to offer more options for phlebotomy and reach more people).

The pharmacists provided four weeks’ worth of hepatitis C medications directly to participants and counselled them on side effects and adherence. Every four weeks, the pharmacists reassessed patients and provided the next four weeks of treatment medications. The PPP-CCM clinical team (pharmacists and physicians) met weekly to discuss clinical questions, and the physicians had access to the participants’ medical records for any additional follow-up that was required. 

The patient navigator was a social worker who helped to identify eligible participants and was trained to provide medical case management, including:

  • education around hepatitis C diagnosis and treatment
  • assessment of reinfection risk and access to harm reduction counselling and services
  • referrals to resources (e.g., insurance, housing, employment)
  • assistance with appointment scheduling and reminders
  • assistance with medication adherence between visits with the pharmacist
  • medication management, including assistance with medication storage and assessment of side effects and adherence

The pharmacists and the patient navigator were present onsite and available to engage with patients on a drop-in basis at the needle and syringe program and opioid treatment program sites, and through referral at the emergency housing units.

The PPP-CCM was developed through consultations with people with lived experience of injection drug use and hepatitis C to assess their prior experiences with, and preferences for, hepatitis C treatment.


Between November 2020 and October 2021, 45 people who inject drugs were screened and 40 enrolled in a pilot study on the PPP-CCM. Among the 40 participants:

  • the mean age was 43.6 years
  • 12 (30%) were women
  • 20 (50%) were non-white
  • 15 (38%) were unhoused

At baseline, 80% of participants reported heroin use, 68% reported methamphetamine use and 38% reported sharing injecting equipment, all in the past 30 days.

Among the 40 enrolled participants, 38 were successfully linked to a pharmacist for initial hepatitis C treatment evaluation. Of those, 21 (55%) received DAA treatment, and 16 of these 21 participants (76%) completed treatment. Among the 21 participants who received treatment, 11 (52%) had SVR12 data available, and 10 of these 11 participants (91%) were found to have achieved cure. Most participants who failed to start treatment did so because of an inability of staff to obtain blood samples for pretreatment evaluations.

In a subsample of participants who completed a six-month post-enrollment survey (10 participants), 100% responded “agree” or “strongly agree” to statements that they had a positive experience with the pharmacist, felt the pharmacist was non-judgmental and would refer other people who inject drugs to the pharmacists for treatment.

What does this mean for service providers?1

This pilot study supports the use of pharmacists in community-based sites for the delivery of hepatitis C treatment for people who inject drugs. It is known that people who inject drugs often face barriers to treatment because there is a lack of speciality providers and treatment is often delivered in more traditional medical settings that can sometimes be stigmatizing. This approach allowed for the delivery of treatment in community-based locations (e.g., an opioid treatment program) where people already access services, using an approach led by non-specialists (i.e., pharmacists).

Future considerations include ways to increase the number of participants who obtain blood draws for the tests necessary to start hepatitis C treatment, as this was a major reason that participants did not start hepatitis C treatment in the pilot study. Loss to follow-up was also an issue even with a patient navigator, so similar approaches should consider additional ways to keep participants engaged in treatment and follow-up care.

Related resources

Co-located hepatitis C testing and care at a supervised consumption service

A flexible and mobile approach to hepatitis C care delivery for people experiencing homelessness


  1. Tsui JI, Gojic AJ, Pierce KA et al. Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs. Drug and Alcohol Dependence Reports. 2024 Mar;10:100213.
  2. Austin EJ, Gojic Aj, Bhatraju EP et al. Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs. International Journal of Drug Policy. 2023 Jan;111:103924.