Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Infectious Diseases, ciae520. https://doi.org/10.1093/cid/ciae520 Dr. Andrew Seaman et al.
Points
- A randomized trial in rural Oregon evaluated the peer-assisted telemedicine model (TeleHCV) for treating hepatitis C virus (HCV) in people who use drugs (PWUD) compared to enhanced usual care (EUC).
- TeleHCV significantly increased treatment initiation, with 85% of participants starting treatment versus 12% in the EUC group (relative risk = 6.7, p<0.001).
- TeleHCV participants achieved higher viral clearance rates at 12 weeks post-treatment (63%) compared to the EUC group (16%) (relative risk = 4.1, p<0.001).
- TeleHCV used peer support for consultations, lab evaluations, medication delivery, and adherence monitoring, addressing barriers to care in underserved populations.
- The TeleHCV model demonstrated scalability and effectiveness, aligning with World Health Organization HCV elimination goals and offering a promising approach for rural, low-resource settings.
Summary
In a randomized controlled trial conducted in seven rural Oregon counties, researchers evaluated the effectiveness of a peer-assisted telemedicine hepatitis C virus (HCV) treatment model (TeleHCV) compared to enhanced usual care (EUC) for people who use drugs (PWUD). The study aimed to address the significant barriers to HCV treatment in rural areas, where fewer than 10% of PWUDs typically access care. Participants, including 203 PWUD with HCV viremia and recent drug use, were randomized to either TeleHCV, which involved telemedicine consultations facilitated by peers, or EUC, which involved referral to local providers. Peers supported participants through screening, lab evaluations, medication delivery, and adherence monitoring for TeleHCV.
Results showed a substantial difference between the two groups in treatment initiation and viral clearance. A total of 85% of TeleHCV participants (85/100) initiated treatment compared to just 12% in the EUC group (13/103) (relative risk [RR] = 6.7, 95% CI 4.0–11.3, p<0.001). Furthermore, 63% of TeleHCV participants (63/100) achieved viral clearance at 12 weeks post-treatment, compared to only 16% in the EUC group (16/103) (RR = 4.1, 95% CI 2.5–6.5, p<0.001). These findings demonstrate that the peer-assisted telemedicine model significantly improved treatment uptake and outcomes in a population traditionally underserved by healthcare systems.
The study concludes that the TeleHCV model substantially increased HCV treatment initiation and viral clearance among PWUD in rural areas by leveraging peer support and telemedicine. These results suggest that the TeleHCV model could be a scalable solution for expanding HCV treatment access and meeting the World Health Organization’s HCV elimination goals, particularly in low-resource, rural settings. Further replication of this model could be pivotal in achieving broader public health objectives for HCV treatment.
Link to the article: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciae520/7909503
References Seaman, A., Cook, R., Leichtling, G., Herink, M. C., Gailey, T., Cooper, J., Spencer, H. C., Babiarz, J., Fox, C., Thomas, A., Leahy, J. M., Larsen, J. E., & Korthuis, P. T. (2024). Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial. Clinical Infectious Diseases, ciae520. https://doi.org/10.1093/cid/ciae520
