Peer telehealth intervention increases HCV treatment initiation, six-month viral clearance
Patients in rural areas who used drugs were four times more likely to achieve clearance of hepatitis C virus (HCV) at six months with a peer telehealth treatment intervention than with a peer-assisted referral to local treatment resources, according to randomized trial results.
A peer telehealth hepatitis C virus (HCV) treatment model substantially increased HCV treatment initiation and viral clearance compared with peer-assisted referral to local health care professionals, results of a randomized controlled trial show.
In seven rural Oregon counties, researchers randomized 100 people who had HCV and used injection drugs or nonprescribed opioids within 90 days to peer-assisted telemedicine HCV treatment and 103 people to enhanced usual care, defined as peer-assisted referral to local professionals. For all participants, peers supported screening and pretreatment laboratory evaluation, and for telehealth participants, peers facilitated telemedicine visits, medication delivery, and adherence. The primary outcome was estimated group differences in HCV viral clearance. HCV treatment initiation and completion were secondary outcomes. Findings were published by Clinical Infectious Diseases on Dec. 17, 2024.
Most participants were male (62%) and White (88%), with recent houselessness (70%), and had used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five percent of telehealth patients initiated treatment compared with 12% of enhanced usual care patients (relative risk [RR], 6.7 [95% CI, 4.0 to 11.3]; P<0.001). Almost half (46%) of participants in the telehealth arm versus 9% of the usual care arm achieved treatment completion (RR, 5.30 [95% CI, 2.70 to 10.20]; P<0.001). At 12 weeks after the anticipated treatment completion date, 63% of telehealth participants versus 16% of enhanced usual care participants achieved viral clearance (RR, 4.1 [95% CI, 2.5 to 6.5]; P<0.001).
Researchers cautioned that the effect size may not be generalizable to higher-density regions with relatively greater access to care. “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,” they concluded.
An accompanying editorial highlighted the success of the intervention, stating that “direct telemedicine is a tool that can and should be used to reach people with HCV who are not engaged in the healthcare system.” However, the editorialists also noted that more support is needed for patients during the treatment process, especially in community settings where risk of disengaging from care is high. The current study fills an important gap in the literature, they concluded, adding “ultimately, peer navigation and telemedicine are critical to HCV elimination because, in different ways, they meet people where they are.”