Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study
Abstract Background The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Orego...
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| Format: | Article |
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BMC
2025-02-01
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| Series: | Addiction Science & Clinical Practice |
| Online Access: | https://doi.org/10.1186/s13722-025-00541-6 |
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| author | Kim Hoffman Gillian Leichtling Sarah Shin Andrew Seaman Tonhi Gailey Hunter C. Spencer P. Todd Korthuis |
| author_facet | Kim Hoffman Gillian Leichtling Sarah Shin Andrew Seaman Tonhi Gailey Hunter C. Spencer P. Todd Korthuis |
| author_sort | Kim Hoffman |
| collection | DOAJ |
| description | Abstract Background The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported Peer TeleHCV study participants in HCV medication adherence. A qualitative investigation queried telemedicine clinicians and peers about their experiences with the implementation of the model and key drivers of implementation effectiveness. Methods Two remote audio/video recorded focus groups were conducted, one with the study’s clinicians and one with the peers. Participants were asked their views of key elements for successful implementation and outcomes of the Peer TeleHCV model. Group interviews lasted one hour. Recordings were professionally transcribed for thematic analysis with a mixed deductive and inductive framework, using Atlas.ti. Patients were surveyed about their interactions and satisfaction with peers. Results Quantitative data (n = 78) indicated patients had high levels of satisfaction with and support from the peers. Three themes were identified from the qualitative data (n = 12) including. (1) Key peer-level elements such as providing support during potentially difficult lab draws, creating a peer-facilitated “bubble of trust” between patients and clinicians, enabling technology access, conducting outreach to maintain contact and support treatment retention, and facilitating stabilizing wrap-around services (e.g., housing vouchers) (2) Key clinician-level factors such as capacity for unscheduled peer-facilitated appointments, having dedicated time for case consults with peers, and clinicians trained in working with PWUD and skilled in identifying related clinical concerns (3) Key systems-level elements such as standing lab orders, challenges related to specialty pharmacies and Medicaid managed care organizations, and streamlined communication strategies between peers and clinicians. Conclusion All participants reported that the Peer TeleHCV model built trust and eased barriers for PWUD initiating and remaining in HCV treatment. This low-barrier model makes space for PWUD to receive HCV treatment, regardless of drug use. Implementing support from peer specialists, telemedicine technology, and streamlined testing and treatment strategies may connect more rural PWUD living with HCV with the cure. |
| format | Article |
| id | doaj-art-90c1a1f105a9439684dc68c33a6db8f0 |
| institution | Kabale University |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-90c1a1f105a9439684dc68c33a6db8f02025-02-09T12:49:12ZengBMCAddiction Science & Clinical Practice1940-06402025-02-0120111210.1186/s13722-025-00541-6Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods studyKim Hoffman0Gillian Leichtling1Sarah Shin2Andrew Seaman3Tonhi Gailey4Hunter C. Spencer5P. Todd Korthuis6Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science UniversityComagine HealthComagine HealthDepartment of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science UniversityOregon Health & Science UniversityDepartment of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science UniversityDepartment of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science UniversityAbstract Background The increase in opioid use disorder among young, nonurban people has fueled sharp rises in hepatitis C virus (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported Peer TeleHCV study participants in HCV medication adherence. A qualitative investigation queried telemedicine clinicians and peers about their experiences with the implementation of the model and key drivers of implementation effectiveness. Methods Two remote audio/video recorded focus groups were conducted, one with the study’s clinicians and one with the peers. Participants were asked their views of key elements for successful implementation and outcomes of the Peer TeleHCV model. Group interviews lasted one hour. Recordings were professionally transcribed for thematic analysis with a mixed deductive and inductive framework, using Atlas.ti. Patients were surveyed about their interactions and satisfaction with peers. Results Quantitative data (n = 78) indicated patients had high levels of satisfaction with and support from the peers. Three themes were identified from the qualitative data (n = 12) including. (1) Key peer-level elements such as providing support during potentially difficult lab draws, creating a peer-facilitated “bubble of trust” between patients and clinicians, enabling technology access, conducting outreach to maintain contact and support treatment retention, and facilitating stabilizing wrap-around services (e.g., housing vouchers) (2) Key clinician-level factors such as capacity for unscheduled peer-facilitated appointments, having dedicated time for case consults with peers, and clinicians trained in working with PWUD and skilled in identifying related clinical concerns (3) Key systems-level elements such as standing lab orders, challenges related to specialty pharmacies and Medicaid managed care organizations, and streamlined communication strategies between peers and clinicians. Conclusion All participants reported that the Peer TeleHCV model built trust and eased barriers for PWUD initiating and remaining in HCV treatment. This low-barrier model makes space for PWUD to receive HCV treatment, regardless of drug use. Implementing support from peer specialists, telemedicine technology, and streamlined testing and treatment strategies may connect more rural PWUD living with HCV with the cure.https://doi.org/10.1186/s13722-025-00541-6 |
| spellingShingle | Kim Hoffman Gillian Leichtling Sarah Shin Andrew Seaman Tonhi Gailey Hunter C. Spencer P. Todd Korthuis Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study Addiction Science & Clinical Practice |
| title | Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study |
| title_full | Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study |
| title_fullStr | Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study |
| title_full_unstemmed | Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study |
| title_short | Peer-assisted telemedicine hepatitis-C treatment for people who use drugs in rural communities: a mixed methods study |
| title_sort | peer assisted telemedicine hepatitis c treatment for people who use drugs in rural communities a mixed methods study |
| url | https://doi.org/10.1186/s13722-025-00541-6 |
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