The study, published in the journal Clinical Infectious Diseases, outlines the results of a randomized controlled trial led by Oregon Health & Science University in seven rural counties in Oregon. The study enlisted people with lived experience in substance use to meet individuals who use drugs, test them for hepatitis C, and then offer them treatment through telehealth or referral to a physical clinic.
The results were striking.
Researchers found that 85% of people successfully enrolled in treatment through a tablet or smartphone compared with only 12% of those who were referred to in-person care at a clinic. Further, the majority of the people who were offered care through telemedicine - 66% - cleared the virus within six months after the study began.
Each approach relied on engaging people through peers with experience in illicit drug use.
"Rural people who use drugs may be more likely to trust their peers, even when they don’t trust health care providers," said lead author Andrew Seaman, M.D., an associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "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."
Hepatitis C is the most common blood-borne virus in the United States, with an estimated 2.4 million people affected.
Corralling the spread of hepatitis C has become much more viable in recent years, with the availability of antiviral therapies that are more than 95% effective in eliminating the virus with few side effects. Yet getting people tested and treated remains a major hurdle in curbing the ongoing spread of the disease and its impact on public health.
"We have life-saving medications to treat hepatitis C," Seaman said. "This study shows that finding unique ways to improve access to treatment - beyond traditional health care settings - is crucial for supporting people who use drugs."
The study randomized 203 individuals in rural areas who use drugs contacted by peers with lived experience in drug use from July 2020 to December 2022.
All participants were referred to care, either through a peer-assisted referral to local treatment resources in their community or through a peer-assisted telemedicine connection to health care professionals via tablet or smartphone.
Those who received care through telehealth were almost seven times more likely to be treated for hepatitis C and four times more likely to achieve viral clearance after six months, the study found.
The research team believes this is the first randomized study to validate telehealth in rural populations living with hepatitis C and the first to evaluate peer-assisted telemedicine. In contrast to other viral epidemics like HIV, hepatitis C prevalence is higher in rural areas and is especially prevalent among people who inject drugs.
Telehealth use generally has skyrocketed since the COVID-19 pandemic, but this study is the first to document its potential to be scaled nationwide in addressing hepatitis C, especially as the Biden administration is focused on a five-year initiative to eliminate the disease in the United States.
"This is one of those rare situations where spending money will actually save money," said Seaman, who also serves as medical director of Hepatitis and HIV Services for Central City Concern, a Portland-area nonprofit that provides housing, health care and addiction treatment services. "Hepatitis C causes liver cancer, loss of productivity, diabetes and all kinds of complications that cost lives and money. And it’s transmissible, so every time a patient is cured, we also prevent multiple transmissions to other people."
Seaman also heads substance use disorder programs with Better Life Partners, which provides low-barrier treatment within a harm reduction framework across New England.
In Oregon, to conduct this research, investigators leveraged an existing initiative known as Oregon HIV/Hepatitis and Opioid Prevention and Engagement, or Oregon HOPE, a collaboration among OHSU, the Oregon Health Authority, Comagine Health and community-based organizations.
The initiative relies on peers in recovery from addiction to engage their neighbors in substance use prevention and treatment services. The program, funded by the National Institute on Drug Abuse of the National Institutes of Health, collaborates with community organizations in Lane, Douglas, Josephine, Curry, Coos, Jackson and Umatilla counties.
"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 co-author Todd Korthuis, M.D., M.P.H., head of addiction medicine at OHSU, professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine, and principal investigator of Oregon HOPE. "It's a deeply gratifying new way of doing business."
Seaman A, Cook R, Leichtling G, Herink MC, Gailey T, Cooper J, Spencer HC, Babiarz J, Fox C, Thomas A, Leahy JM, Larsen JE, Korthuis PT.
Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial.
Clin Infect Dis. 2024 Nov 27:ciae520. doi: 10.1093/cid/ciae520