Journal Article

A randomized controlled trial for a peer-facilitated telemedicine hepatitis c treatment intervention for people who use drugs in rural communities: study protocol for the “peer tele-HCV” study

Gailey, Tonhi, Cook, Ryan, Seaman, Andrew, Larsen, Jessica E., Herink, Megan C., Thomas, Ann, Leichtling, Gillian, Korthuis, P. Todd

2023

Overview

Background Hepatitis C virus (HCV) transmission is primarily driven by injection drug use, and acute HCV infection rates are increased in rural communities with substantial barriers to care. Treatment of HCV in persons who use drugs (PWUD) is cost effective, decreases high risk behaviors and HCV transmission, and achieves high rates of treatment completion and sustained viral response. Adapting HCV care delivery to utilize peer support specialists, telemedicine technology, and streamlined testing and treatment strategies can better reach rural populations living with HCV. Methods This is an open label, two-arm, non-blinded, randomized controlled trial designed to test the superiority of peer-facilitated and streamlined telemedicine HCV care (peer tele-HCV) compared to enhanced usual care (EUC) among PWUD in rural Oregon. In the intervention arm, peers conduct HCV screening in the community, facilitate pretreatment evaluation and linkage to telemedicine hepatitis C treatment providers, and support participants in HCV medication adherence. For participants assigned to EUC, peers facilitate pretreatment evaluation and referral to community-based treatment providers. The primary outcome is sustained virologic response at 12 weeks post treatment (SVR12). Secondary outcomes include: (1) HCV treatment initiation, (2) HCV treatment completion, (3) engagement with harm reduction resources, (4) rates of substance use, and (5) engagement in addiction treatment resources. The primary and secondary outcomes are analyzed using intention-to-treat (ITT) comparisons between telemedicine and EUC. A qualitative analysis will assess patient, peer, and clinician experiences of peer-facilitated telemedicine hepatitis C treatment. Discussion This study uses a novel peer-based telemedicine delivery model with streamlined testing protocols to improve access to HCV treatment in rural communities with high rates of injection drug use and ongoing disease transmission. We hypothesize that the peer tele-HCV model will increase treatment initiation, treatment completion, SVR12 rates, and engagement with harm reduction services compared to EUC. Trial registration This trial has been registered with ClinicalTrials.gov (clinicaltrials.gov NCT04798521)

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Addictions / Analysis / Antiviral agents / Antiviral Agents - therapeutic use / Blood diseases / Care and treatment / Clinical outcomes / Clinical trials / Community / Community-based treatment / Control / Cost analysis / Direct acting antivirals / Disease transmission / Drug abuse / Drugs / Equivalence Trials as Topic / Focus groups / Harm reduction / Health aspects / Health Psychology / Hepacivirus / Hepatitis / Hepatitis C / Hepatitis C - diagnosis / Hepatitis C - drug therapy / Hepatitis C - epidemiology / Hepatitis C virus / Hepatitis C, Chronic - diagnosis / Hepatitis C, Chronic - drug therapy / High risk / Humans / Infection / Intervention / Medical referrals / Medical research / Medical screening / Medical technology / Medical treatment / Medicine / Medicine & Public Health / Medicine, Experimental / Patient compliance / Peer-facilitated treatment / Peers / People who use drugs / Pharmaceutical Preparations / Pharmacology/Toxicology / Psychopharmacology / Public Health / Qualitative research / Randomized Controlled Trials as Topic / Registration / Risk behavior / Rural areas / Rural communities / Rural Population / Social support / Social Work / Specialists / Study Protocol / Substance abuse / Substance abuse treatment / Telecommunications / Telehealth / Telemedicine / Tests / Treatment compliance / Viruses