Peer-Assisted Telemedicine for Hepatitis C in People Who Use Drugs: A Randomized Controlled Trial

Area of Science:

• Hepatology and Infectious Diseases
• Public Health and Epidemiology
• Telemedicine and Digital Health

Background:

• Hepatitis C virus (HCV) elimination is hindered by low treatment access among people who use drugs (PWUD).
• Rural communities face particular challenges in accessing HCV treatment for PWUD.
• Less than 10% of PWUD in the US receive HCV treatment.

Purpose of the Study:

• To evaluate the effectiveness of a peer-assisted telemedicine model for HCV treatment in rural populations.
• To compare HCV treatment initiation, completion, and viral clearance rates between telemedicine and enhanced usual care.

Main Methods:

• Randomized controlled trial involving PWUD with HCV viremia in rural Oregon.
• Intervention group received peer-assisted telemedicine HCV treatment (TeleHCV).
• Control group received peer-assisted referral to local providers (enhanced usual care - EUC).

Main Results:

• 85% of TeleHCV participants initiated treatment versus 12% in EUC (RR 6.7).
• 63% of TeleHCV participants achieved viral clearance versus 16% in EUC (RR 4.1).
• The study involved 203 participants, predominantly male, White, with recent homelessness and high rates of methamphetamine and opioid use.

Conclusions:

• The Peer TeleHCV model significantly improved HCV treatment initiation and viral clearance.
• Decentralizing HCV treatment through telemedicine can expand access for PWUD in rural and low-resource settings.
• This approach supports World Health Organization goals for HCV elimination.