The incidence rates for hepatitis C has increased significantly in rural areas across the US. One study pointed out that the number of cases had more than double in rural areas vs urban areas.1 This increase has also been linked to injection drug use with 75% of the individuals followed in the study having reported engaged in this activity. Much of these developments stem from the prescription opioid crisis with people possibly starting with opioids and progressing to illicit drug use.1
Additionally, getting people in rural areas with hepatitis C into the continuum of care can be difficult, especially with limited, nearby medical institutions and programs or having a network of peers who might also be affected with the same affliction.
With these inherent challenges, a new study published recently in the journal, Clinical Infectious Diseases, demonstrated the success of getting people who use drugs into the continuum of care for HCV through a community-based peer support telemedicine approach. The study evaluated enlisting people with a lived experience of substance abuse and having them meet others who use drugs, try to get them tested for the blood borne disease and into treatment via telehealth or referral to a physical clinic.2
“Rural people who use drugs may be more likely to trust their peers, even when they don’t trust health care providers,” lead author Andrew Seaman, MD, an associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine, said. 2
What You Need to Know
Hepatitis C rates have significantly increased in rural areas across the U.S., more than doubling compared to urban areas. This rise is strongly linked to injection drug use, with 75% of study participants reporting such activity.
A study demonstrated the effectiveness of peer-assisted telemedicine (TeleHCV) in addressing hepatitis C among people who use drugs in rural areas. Using peer support to engage participants led to significantly higher treatment initiation (85% in TeleHCV vs. 13% in usual care) and cure rates (63% vs. 16%).
A lack of nearby healthcare facilities and peer support networks complicates engagement in the care continuum for people with hepatitis C.
The Study Specifics
Peers with a shared drug use experience recruited other people who use drugs (PWUD) in 7 rural counties in Oregon where there were higher incidence rates ofhepatitis C and opioid overdoses. 3
Study criteria included individuals who were at least 18 years of age or older, lived within the study area, had injected drugs or used non-prescribed opioids within 90 days of screening, and had a detectable HCV. For nearly 2 ½ years, from July 17, 2020 to December 12, 2022, 774 people were screened, 227 had detectable HCV RNA, and 203 participants were randomized with 100 of the participants assigned to peer-assisted telemedicine hepatitis C treatment (TeleHCV) and 103 participants were placed into the peer-assisted referral to local providers enhanced usual care (EUC).3
“Eighty-five percent (85/100) of participants randomized to the TeleHCV arm initiated treatment compared to 13% (13/103) of EUC (RR = 6.70, 95% CI 4.00, 11.30, p < .001),” the investigators wrote.3
In addition, viral clearance or functional cure, was achieved in 63% of people in the TeleHCV group vs just 16%in the EUC group.
“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 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 said.”2
References
1. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012. Clin Infect Dis. 2014;59(10):1411-1419. doi:10.1093/cid/ciu643
2. Robinson E. Telehealth plus local peer support boosts treatment success for hepatitis C in rural patients. Oregon Health & Science University News. November 27, 2024. Accessed December 17, 2024. https://news.ohsu.edu/2024/11/27/telehealth-significantly-boosts-treatment-success-for-hepatitis-c-in-rural-patients
3. Seaman A, Cook R, Leichtling G, et al. Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial. Clin Infect Dis. Published online November 27, 2024. doi:10.1093/cid/ciae520
