Telehealth program helps improve hepatitis C treatment in rural US
Clinical trial finds success with peer-supported telemedicine initiative
A peer-supported telemedicine program in the U.S. significantly increased the likelihood that hepatitis C patients in rural communities would start treatment — and ultimately clear the infection — compared with referrals to a physical clinic.
That’s according to new data from a clinical trial called TeleHepC (NCT04798521), which involved about 200 people with a recent history of drug use who were living in difficult-to-reach communities in rural Oregon.
The telehealth program relied heavily on peer support from people in recovery from past drug use to connect infected individuals with treatment.
The data showed that more than 8 in 10 of these hard-to-reach patients were enrolled in treatment with the help of a tablet or smartphone. That compared with slightly more than 1 in 10 people referred to in-person care who started treatment. Moreover, two-thirds of the patients using the peer-assisted telehealth program cleared the virus, according to the researchers.
“This study shows the importance of empowering trusted peers to support the health of people who use drugs, and the crucial role telemedicine can play to expand hepatitis C treatment to rural communities,” Andrew Seaman, MD, the study’s first author and an associate professor at the Oregon Health & Science University (OHSU) School of Medicine, said in a university news story.
The study, “Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial,” was published in the journal Clinical Infectious Diseases.
Telehealth program aims to connect drug users with hepatitis C treatment
Hepatitis C is a viral infection that, like other forms of hepatitis, leads to liver inflammation. About half of people infected with the hepatitis C virus, known as HCV, will develop a chronic infection that can ultimately cause serious liver damage if left untreated.
HCV is transmitted via exposure to blood from an infected person. The most common mode of transmission is through sharing contaminated needles or other equipment that’s used to prepare and inject recreational drugs.
An ongoing World Health Organization campaign is working to eliminate viral hepatitis globally by 2030 — which aligns with similar U.S. efforts to eliminate hepatitis C in that country within the next five years.
While very effective antiviral therapies are available for clearing the HCV virus, getting people tested and treated is still a barrier to its elimination. This is especially true for patients in rural areas, where healthcare services are less accessible, and for those in lower socioeconomic classes who may not have insurance.
Telemedicine, in which healthcare services are provided remotely via phone or video, has been shown to help remove barriers to care and improve health outcomes in various settings.
TeleHepC trial enrolled over 200 adults in rural areas of Oregon
The TeleHepC trial was designed to learn more about how a telehealth program might help better connect HCV-infected drug users with hepatitis C treatment.
It enrolled 203 adults who had injected drugs or used noninjected recreational opioids during the prior three months, and who had chronic active, untreated HCV infection. These patients were recruited by peers with lived experience in drug use across seven rural counties in Oregon.
Most patients were men (62%), were white individuals (88%), and had recently experienced homelessness (70%). Most reported using methamphetamines (88%) or fentanyl/heroin (58%) in the previous month.
The participants were randomly assigned to a care protocol — receiving either telemedicine HCV treatment by meeting with a healthcare provider via tablet or smartphone (TeleHCV) or being referred to see local providers in person (usual care).
With both approaches, participants engaged regularly with peers who had past experience with illicit drug use but who were now in recovery. These peers helped connect the participants to treatment and aided in navigating any barriers or difficulties they experienced throughout the process.
According to the researchers, the program relied on an existing collaborative initiative called Oregon HOPE, which engages peers in recovery to help connect their neighbors with active substance use problems with prevention and treatment.
The rationale for that approach is that “rural people who use drugs may be more likely to trust their peers, even when they don’t trust health care providers,” Seaman said.
Over 80% of patients receiving telemedicine began treatment in trial
The results showed that 85% of those assigned to TeleHCV began treatment, compared with 12% of those in the usual care group. This reflected a nearly seven times greater chance of treatment initiation with the telemedicine program relative to in-person care.
Moreover, significantly more TeleHCV participants — 63% versus 16% — achieved clearance of the virus in their blood three months after they were expected to have completed a course of treatment relative to the usual care group. That made the TeleHCV patients four times more likely to eliminate the infection.
“This study shows that finding unique ways to improve access to treatment — beyond traditional healthcare settings — is crucial for supporting people who use drugs,” Seaman said.
The scientists attributed much of the program’s success to its peer-based approach.
This study teaches us that local peers in rural communities can deliver care directly to people who often slip through the cracks of our health care system. … [It’s] a deeply gratifying new way of doing business.
Todd Korthuis, MD, the study’s senior author and the principal investigator of Oregon HOPE, called this initiative “a deeply gratifying new way of doing business.”
The Oregon HOPE program is funded by the National Institute on Drug Abuse, part of the National Institutes of Health, and collaborates with community organizations across several counties in the state.
“This study teaches us that local peers in rural communities can deliver care directly to people who often slip through the cracks of our health care system,” said Korthuis, also a professor at the OHSU School of Medicine, and the head of addiction medicine at OHSU.
The researchers believe their program could be scaled up to help improve hepatitis C elimination efforts across the U.S. and reach the WHO and nationwide goals.
According to Seaman, “this is one of those rare situations where spending money will actually save money.” Seaman noted that “hepatitis C causes… all kinds of complications that cost lives and money,” and as it is transmissible, “every time a patient is cured, we also prevent multiple transmissions to other people.”
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