Peer-assisted telemedicine boosts HCV treatment, viral clearance rates

Peer-assisted telemedicine may successfully increase treatment rates in patients with hepatitis C virus (HCV) who use drugs, especially in rural areas, a study found.

Researchers in Oregon randomly assigned patients with HCV viremia who had used an injection drug or nonprescribed opioids in the past 90 days to HCV treatment via peer-assisted telemedicine (teleHCV) or to enhanced usual care, defined as peer-assisted referral to local clinicians. Peers supported HCV screening and pretreatment laboratory evaluation for all participants but also facilitated telemedicine visits, medication delivery, and adherence for teleHCV participants. The teleHCV clinical team included two internal medicine physicians, a physician assistant, and a clinical pharmacist who offered same-day unscheduled appointments, direct communication with peers to discuss patient concerns, and follow-up adherence calls every four weeks. Follow-up visits were scheduled at one, three, six, and nine months. The trial's primary outcome was HCV viral clearance, defined as undetectable HCV RNA at 12 weeks after treatment completion for those who initiated treatment and as undetectable HCV RNA nine months after randomization for those who did not. HCV treatment initiation and completion were secondary outcomes. The results were published by Clinical Infectious Diseases on Dec. 17.

Two hundred and three participants were included in the study, 100 assigned to teleHCV and 103 assigned to enhanced usual care. Most patients (62%) were men, the mean age was 42 years, and 88% were White. Seventy percent reported having recently been unhoused, and 88% and 58% reported using methamphetamines or fentanyl/heroin, respectively, in the past 30 days. Eighty-two percent reported injection drug use in the past 30 days, and of these, 18% said they had shared syringes at least once. Overall, 85% of teleHCV participants initiated HCV treatment versus 12% of those assigned to enhanced usual care (relative risk [RR], 6.7 [95% CI, 4.0 to 11.3]; P<0.001) and 46% and 9%, respectively, completed treatment (RR, 5.30 [95% CI, 2.70 to 10.20]; P<0.001). Sixty-three percent in the teleHCV group and 16% in the enhanced usual care group achieved viral clearance 12 weeks after the anticipated date of treatment completion (RR, 4.1 [95% CI, 2.5 to 6.5]; P<0.001).

The study was conducted only in rural Oregon, may have been affected by the COVID-19 pandemic, and relied on self-report of treatment completion and adherence, the authors noted. “In this randomized controlled trial, rural [people who use drugs] with HCV offered peer-assisted telemedicine HCV treatment were four times more likely to achieve viral clearance at 6 months after randomization than those with peer-assisted referral to local treatment resources,” they wrote. “Our findings suggest that a peer-assisted telemedicine treatment model offers a powerful new tool for rural communities and policy makers working to eliminate HCV.”