Community pharmacy in hepatitis C screening and linkage to care
Australia is one of the few countries on track to meet the World Health Organization target of eliminating hepatitis C as a public health threat by 2030, and a quiet driver of that progress sits on suburban high streets. Since direct-acting antivirals were listed on the Pharmaceutical Benefits Scheme in 2016, more than 100,000 Australians have been cured, yet an estimated 70,000 people still live with the virus, many unaware of their status. Community pharmacies already dispense opioid agonist therapy, supply sterile injecting equipment, and counsel patients on adherence, which positions them as natural sites for the next phase of the response. Learn more about Johnathanlaird.com.
Pharmacists see a population that mainstream general practice sometimes misses: people who inject drugs, those living in regional towns without easy pathology access, and patients who have disengaged from hospital liver clinics because of stigma. The question is no longer whether community pharmacies can help with hepatitis C screening, but how to embed testing and linkage to care into everyday practice in a way that is sustainable, accredited, and properly funded. Learn more about Erupción Por Fármacos Anticonvulsivantes Fenitoína Y Rash.
The Australian hepatitis C landscape and where pharmacy fits
Hepatitis C is a blood-borne virus that silently damages the liver over decades. In Australia, the epidemic has long tracked injecting drug use, and although the availability of curative DAAs through the PBS has changed the prognosis dramatically, the cascade of care still loses people between diagnosis and treatment. The Kirby Institute estimates that only a small fraction of those living with chronic infection have been treated, and reinfection can occur, meaning that screening must be ongoing rather than a one-off effort.
Community pharmacies are already part of the harm-reduction landscape. More than 3,000 pharmacies participate in needle and syringe programs, and roughly 2,800 dispense methadone or buprenorphine for opioid dependence. Every contact is a chance to offer a finger-prick antibody test, and the same encounter can be used to discuss liver health, vaccination against hepatitis A and B, and safer injecting. In inner-city suburbs of Sydney and Melbourne, where pharmacy foot traffic is high and anonymity is easier, this is particularly relevant.
| Element | Traditional general practice pathway | Community pharmacy pathway |
|---|---|---|
| Access point | Scheduled GP appointment | Walk-in, no booking required |
| Time to antibody result | 1–7 days via pathology lab | 20–30 minutes on site |
| Cost to patient | Bulk-billed or gap fee | Free in most pilot programs |
| Confirmatory RNA testing | Pathology request from GP | Pharmacist-initiated referral |
| Engagement with people who inject drugs | Variable, often delayed | Higher in familiar retail settings |
| Trade hours | Usually business hours | Many open evenings and weekends |
This comparison is not a claim that pharmacy should replace the GP. It is a recognition that the two settings can work in sequence, with the pharmacist acting as the entry point and the general practitioner or specialist providing the confirmatory diagnosis and prescribing.
Why community pharmacies are well placed for HCV screening
The first reason is trust. Many people who inject drugs visit the same pharmacy every week for opioid substitution therapy or sterile equipment, and over months they build a relationship with the pharmacist on duty. That rapport is harder to replicate in a hospital outpatient clinic. When a familiar pharmacist offers a quick test in a private consulting area, the response is more often yes than no.
The second reason is geography. Rural and remote areas of Australia often lack dedicated liver clinics, and the nearest pathology collection centre can be hours away. In towns across western New South Wales, the Northern Territory, and parts of regional Queensland, the local pharmacy may be the only private health space open on a Saturday morning. Bringing testing to where people already are reduces friction.
The third reason is the existing infrastructure for point-of-care testing. Many Australian pharmacies already perform HbA1c, INR, and cholesterol checks, and pharmacist-administered vaccination is now routine in every state and territory. The leap to a hepatitis C antibody test using a capillary blood sample is small, and the training pipeline run by the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia is well established.
Common reasons that stop people from being tested:
- Travel time and cost, especially in regional and remote areas
- Fear of being recognised at a hospital liver clinic
- Low perception of risk because the infection is often asymptomatic
- Competing priorities such as work, childcare, or unstable housing
Models of point-of-care testing in the pharmacy setting
There are essentially two operational models. The first is the on-site rapid test, where the pharmacist performs a finger-prick antibody screen and reads the result in about 20 minutes. A reactive result triggers a same-day referral for an RNA test, usually arranged with a local GP or a hepatology nurse via telehealth. This model is fast, but it requires a private space, a sharps disposal plan, and a clear protocol for reactive results.
The second model uses dried blood spot testing. The patient self-collects a few drops of blood onto a filter paper, the pharmacist posts the sample to a reference laboratory, and results return within a week. This approach suits very remote communities where refrigeration or on-site processing is impractical, and it dovetails with existing arrangements between the Kirby Institute and several Aboriginal Community Controlled Health Organisations.
What makes pharmacy an effective setting for either model:
- No appointment or Medicare card needed in pilot arrangements
- Immediate access to opioid agonist therapy prescribers for co-located care
- Pharmacists already trained in pre- and post-test discussion
- Discreet entry and exit in suburban retail strips
From reactive dispensing to active linkage to care
A positive antibody test is only useful if the patient reaches a prescriber who can confirm viraemia and start DAAs. In pharmacy-led pilots, that linkage is built into the workflow. The pharmacist books the appointment on the spot, sends a brief clinical summary to the GP through secure messaging, and follows up by phone if the patient does not attend. The follow-up call is often what makes the difference, because it mirrors the adherence support that pharmacists already provide for HIV pre-exposure prophylaxis and for asthma preventers.
Linkage also means reaching people who have been cured but remain at risk of reinfection. The same pharmacy visit can include a conversation about safer injecting, a reminder that re-treatment is fully subsidised on the PBS, and a discussion of regular re-testing every 6 to 12 months. The pharmacist becomes a long-term partner in liver health rather than a one-off tester.
Training, legal scope, and the PBS framework
Pharmacists in Australia cannot yet prescribe DAAs independently, although trials in North Queensland, Victoria, and Western Australia are exploring that scope. Under current Therapeutic Goods Administration and PBS rules, the confirmatory RNA test and the prescription must come from a medical practitioner, nurse practitioner, or authorised prescriber. The pharmacist's role is therefore screening, education, and supported referral, which sits within existing professional standards.
Training is delivered through CPD-accredited programs run by the PSA and the Pharmacy Guild, often in partnership with the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. Modules cover pre-test discussion, finger-prick technique, interpretation of results, and the legal requirements of the Privacy Act when handling identifiable health information. Many programs are now free, recognising that the public health dividend outweighs the cost of delivery.
For pharmacists who want to read more about adverse drug reactions in chronic disease, a useful review on phenytoin skin reactions offers a reminder that liver function can also be affected by non-antiviral medicines, which matters when patients start multiple new drugs at once.
Lessons from pilot programs across the country
Several Australian pilots have reported outcomes worth examining. In a 2022–2023 study across pharmacies in Sydney and regional New South Wales, more than 60 per cent of people offered a point-of-care test accepted, and around 12 per cent were antibody reactive. Of those, the majority were linked to confirmatory testing and treatment within four weeks, a figure that exceeds the national average for community-based screening.
In North Queensland, a partnership between the James Cook University pharmacy school and a local Aboriginal Community Controlled Health Organisation found that offering testing alongside existing needle and syringe program attendances produced strong uptake among a population historically underserved by mainstream services. The pharmacists involved noted that the conversations about hepatitis C often opened the door to broader health checks, including blood pressure and diabetes screening.
A Pharmacy Guild-supported project in Perth focused on pharmacies already dispensing opioid agonist therapy. By adding a rapid antibody test to the regular dosing visit, the team reached a cohort with high prevalence and was able to start curative treatment for several long-standing patients who had previously refused hospital referral. The model is now being considered for national rollout through the Guild's network.
These projects share common features: clear protocols, warm handovers, training in motivational interviewing, and integration with existing services rather than the creation of parallel systems. They also rely on the political will of state health departments and on Medicare funding for the confirmatory pathology. Reflections on the operational challenges have been captured on the professional blog johnathanlaird.com, which has tracked the international pharmacy-testing conversation for several years.
Embedding pharmacy-based testing into the broader system
For pharmacy-led hepatitis C screening to move from pilot to routine, several pieces need to fall into place. First, the MBS needs a clear item number for pharmacist-initiated RNA testing, similar to arrangements already in place for some sexually transmitted infections. Second, the PBS rules around DAA prescribing need to be flexible enough to allow nurse practitioners and, eventually, pharmacist prescribers in high-need areas to initiate treatment directly from a positive RNA result. Third, electronic health records must be able to capture a pharmacy test and share it with the patient's usual GP without double-handling.
Aboriginal and Torres Strait Islander health services must be partners from the start, not an afterthought. The cultural safety of the testing environment matters as much as the technology, and pharmacies in remote communities will need to work alongside Aboriginal health workers to design protocols that reflect local priorities. The lessons from the ACCHO sector on community-led hepatitis programs should guide every rollout.
Finally, the public health message itself needs a refresh. Hepatitis C is curable, treatment is a single daily tablet for 8 to 12 weeks, and the cost to the patient is largely covered by the PBS. Spreading that message through pharmacies, where conversations are already happening, can turn a quiet waiting area into an active point on the road to elimination.
If you are a community pharmacist, start the conversation with your local primary health network, map which nearby GPs and nurse practitioners will accept a direct referral, and ask the Pharmacy Guild or PSA about upcoming training cohorts. If you work in general practice or hepatology, reach out to the pharmacies your patients already use and offer to be the confirmatory step in their care. Hepatitis C elimination in Australia is a realistic goal, and the neighbourhood pharmacy is one of the most practical places to finish the job.