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

Abstract

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.