Integrating Hepatitis C Virus Services for People Who Use Drugs into Inpatient Substance Use Disorder Treatment Programs Via Telehealth.

BACKGROUND

Achieving hepatitis C virus (HCV) elimination goals requires a test and treat approach in high-prevalence settings. Clients admitted to inpatient substance use treatment programs (ISUTPs) have a high burden of HCV infection, yet routine screening and treatment are not standard practice in these settings.

METHODS

A telehealth model of HCV treatment was implemented at four ISUTPs (spokes) in partnership with a primary care program (hub) with the goal of starting clients on treatment at the ISUTP. Continuous process evaluation identified implementation barriers, which were addressed through the introduction of a community health worker (CHW) model of telehealth facilitation, cocredentialing of the CHW at spoke sites, and partnership with the onsite pharmacy at the hub.

RESULTS

Over the course of 3 years, 164 clients completed an initial telehealth visit at the ISUTP. Among those evaluated, 80% reported recent intravenous drug use, and 51% were unhoused. One hundred and seven (65%) initiated HCV treatment, and 44 (41%) had sustained virologic response (SVR) at 12 weeks posttreatment. As the model of care was refined, more patients started on treatment while at the ISUTP.

CONCLUSIONS

These data demonstrate the feasibility of a test and treat approach for HCV in ISUTPs through a facilitated telehealth model. While documented SVR rates were low compared to other studies, this strategy nonetheless has the potential to reduce HCV transmission at a population level. Future efforts should focus on expanding this model and minimizing loss to follow-up postdischarge from the ISUTP.