Pharmacist-Led HCV Program Uncovers Syndemic Risks, Supports Expanded Screening

A pharmacist-led initiative to screen and treat hepatitis C virus (HCV) in the emergency department (ED) has dramatically improved treatment outcomes and unveiled critical gaps in care for other syndemic infections, according to new research presented at the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Futures meeting.¹

The study, conducted at University of Kentucky Healthcare, evaluated over 33,000 patients screened for HCV between June 2023 and June 2024. The findings revealed significant rates of coinfection with HIV, hepatitis B virus (HBV), and syphilis—highlighting opportunities for pharmacists to broaden their impact in infectious disease management.¹

A Public Health Imperative Meets Pharmacy Innovation

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HCV affects an estimated 4 million people in the US, and left untreated, can lead to liver failure, hepatocellular carcinoma, and death.² Historically, only about 10% of patients diagnosed with HCV in ED settings receive timely treatment, according to the researchers at ASHP Pharmacy Futures.¹

In 2023, University of Kentucky Healthcare launched a pharmacist-led program in its ED and affiliated primary care sites to change that narrative. By streamlining HCV testing, assessment, and initiation of treatment, the program boosted treatment rates to 54% and reduced median time to therapy from 420 to just 17 days.¹

As part of routine care, patients screened for HCV were also tested for HIV and HBV. However, syphilis testing was not consistently performed, despite emerging data suggesting high rates of coinfection.³

Study Design and Methods

Researchers conducted a retrospective cross-sectional analysis of adult patients who received HCV antibody screening in the ED or at primary care sites affiliated with University of Kentucky Healthcare between June 1, 2023, and June 1, 2024. Pediatric patients were excluded from the study. In addition to HCV testing, data from screenings for other syndemic infections—including HIV, HBV, and syphilis—were collected if they occurred during the same encounter or prior to it.¹

For each encounter, the study team extracted laboratory results for HCV antibody and RNA tests, HIV antibody and viral load, HBV surface antigen, and both treponemal and nontreponemal tests for syphilis. The researchers grouped encounters based on which infections were screened to explore predictors of coinfection.¹

The primary outcome was the incidence of coinfection among patients who had HCV screening. Secondary outcomes included the overall screening rates for HIV, HBV, and syphilis, as well as the likelihood of coinfection based on demographic characteristics and HCV test results. Statistical analysis included univariable logistic regression to identify factors associated with positive syndemic tests, followed by adjusted multivariable logistic regression to control for confounding variables.¹

Key Findings

Among the 33,500 patients screened for HCV during the study period, 6.81% tested positive for HCV antibodies. The coinfection rates with other diseases were relatively lower, with 0.64% testing positive for HIV, 0.21% for HBV, and 0.35% for syphilis.¹

Despite the relatively low overall rates, HCV antibody positivity was strongly associated with increased odds of coinfection. Patients who tested positive for HCV antibodies were more than twice as likely to also test positive for HIV, with an OR of 2.68 (95% CI, 1.86-3.86). The odds of HBV coinfection were even higher, with an OR of 3.40 (95% CI, 2.11-5.47). Notably, syphilis also showed a statistically significant association, with HCV-positive patients having 1.60 times the odds of syphilis positivity (95% CI, 1.01-2.54).¹

One of the most striking observations was the low rate of syphilis screening—only 4.78% of patients received testing for syphilis. Yet among those tested, 7.4% were found to be positive, suggesting that the true prevalence of syphilis among this patient population may be substantially underestimated.¹

Implications for Pharmacy Practice

The study authors concluded that patients who test positive for HCV are significantly more likely to be coinfected with HIV, HBV, and syphilis. These syndemics—clusters of reinforcing epidemics—are well documented among vulnerable populations, especially those with substance use disorders or unstable housing. According to the CDC, coinfection complicates treatment and increases the risk of transmission to others.⁴

Given the success of the HCV program at University of Kentucky Healthcare, researchers recommend expanding pharmacist-led screening and treatment services to include syphilis. Early detection could improve clinical outcomes and reduce community spread, especially in high-risk populations that frequent EDs.¹

Looking Ahead

This study reinforces the growing role of pharmacists in public health and infectious disease management. By integrating expanded screening protocols into existing pharmacist-led models, institutions like University of Kentucky Healthcare may not only improve individual outcomes but also help stem the tide of multiple concurrent epidemics.¹

As health care systems continue to grapple with workforce shortages and strained primary care access, pharmacist-led models like this one could serve as scalable, impactful solutions to address complex public health needs.

REFERENCES

1. Le A. Assessing rates of co-infection in patients screened for hepatitis C in an academic medical center. Presented at: American Society of Health-System Pharmacists 2025 Pharmacy Futures. Charlotte, NC; June 10, 2025.

2. Hepatitis C Basics. CDC. Updated January 31, 2025. Accessed June 10, 2025. https://www.cdc.gov/hepatitis-c/about/index.html

3. Thompson LA, Plitt SS, Gratrix J, Charlton CL. Prevalence of syphilis coinfection in hepatitis C virus positive prenatal patients from Alberta during a pilot routine screening program. Can Liver J. 2023;6(1):70-75. doi:10.3138/canlivj-2022-0017

4. Turning the Tide on STIs: Integrating Services to Address the Syndemic of STIs, HIV, Substance Use, and Viral Hepatitis. CDC. November 2024. Accessed June 10, 2025. https://www.cdc.gov/sti/media/pdfs/2024/11/Syndemic-Infographic-11-08-2024.pdf