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Randomized Controlled Trial
. 2025 Mar 17;80(3):501-508.
doi: 10.1093/cid/ciae520.

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

Andrew Seaman  1 , Ryan Cook  1 , Gillian Leichtling  2 , Megan C Herink  3 , Tonhi Gailey  4 , Joanna Cooper  4 , Hunter C Spencer  4 , Jane Babiarz  4 , Christopher Fox  4 , Ann Thomas  5 , Judith M Leahy  6 , Jessica E Larsen  4 , P Todd Korthuis  1
Affiliations
Randomized Controlled Trial

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

Andrew Seaman et al. Clin Infect Dis. .

Abstract

Background: Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet <10% of PWUD in the United States access HCV treatment; access is especially limited in rural communities.

Methods: We randomized PWUD with HCV viremia and past 90-day injection drug or nonprescribed opioid use in 7 rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care [EUC]). Peers supported screening and pretreatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants. Generalized linear models estimated group differences in HCV viral clearance (primary outcome) and HCV treatment initiation and completion (secondary outcomes).

Results: Of the 203 randomized participants (100 TeleHCV, 103 EUC), most were male (62%), White (88%), with recent houselessness (70%), and used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five of 100 TeleHCV participants (85%) initiated treatment versus 13 of 103 (12%) EUC participants (relative risk [RR], 6.7 [95% confidence interval {CI}, 4.0-11.3]; P < .001). Sixty-three of 100 (63%) TeleHCV participants versus 16 of 103 (16%) EUC participants achieved viral clearance 12 weeks after anticipated treatment completion date (RR, 4.1 [95% CI: 2.5-6.5]; P < .001).

Conclusions: The Peer TeleHCV treatment model substantially increased HCV treatment initiation and viral clearance compared to EUC. Replication in other rural and low-resource settings could further World Health Organization HCV elimination goals by expanding and decentralizing treatment access for PWUD. Clinical Trials Registration. NCT04798521.

Keywords: hepatitis C virus; injection drug use; peer support; rural; telemedicine.

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Conflict of interest statement

Potential conflicts of interest. A. S. has participated in investigator-initiated research funded by Merck, AbbVie Pharmaceuticals, and the Gilead Focus Foundation not related to this manuscript. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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References

    1. Cui F, Blach S, Mingiedi CM, et al. . Global reporting of progress towards elimination of hepatitis B and hepatitis C. Lancet Gastroenterol Hepatol 2023; 8:332–42. - PubMed
    1. Thompson WW, Symum H, Sandul A, et al. . Vital signs: hepatitis C treatment among insured adults—United States, 2019–2020. MMWR Morb Mortal Wkly Rep 2022; 71:1011–7. - PMC - PubMed
    1. Ryerson AB, Schillie S, Barker LK, Kupronis BA, Wester C. Vital signs: newly reported acute and chronic hepatitis C cases―United States, 2009–2018. MMWR Morb Mortal Wkly Rep 2020; 69:399–404. - PMC - PubMed
    1. Hoenigl M, Abramovitz D, Flores Ortega RE, Martin NK, Reau N. Sustained impact of the coronavirus disease 2019 pandemic on hepatitis C virus treatment initiations in the United States. Clin Infect Dis 2022; 75:e955–61. - PMC - PubMed
    1. Falade-Nwulia O, Gicquelais RE, Astemborski J, et al. . Hepatitis C treatment uptake among people who inject drugs in the oral direct-acting antiviral era. Liver Int 2020; 40:2407–16. - PMC - PubMed

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