mHealth Intervention May Help Increase HCV Testing Among High-Risk Opioid Users

Karli Hochstatter, MPH, PhD

A new study suggests mobile health interventions among those with opioid use disorder may help increase uptake of hepatitis C virus (HCV) testing among high-risk patients.

A team led Karli Hochstatter, MPH, PhD, School of Social Work, Columbia University, used the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), a smartphone-delivered relapse prevention system, to provide HCV-related and educational content to patients.

“The growing epidemic of opioid use disorder and associated injection drug use has resulted in a surge of new HCV infections, wrote Hochstatter and colleagues. “Improving HCV awareness and increasing screening among people with opioid use disorder are critical.”

mHealth Intervention

The investigators enrolled 416 patients with opioid use disorder between April 2016 and April 2020.

Patients were then randomly assigned 1:1 to receive medications for addiction treatment (MAT) alone or MAT plus A-CHESS platform.

Those in the intervention cohort received private messages tailored to the individuals’ stage of HCV care—ranging from having never been tested for HCV to receiving HCV antiviral therapy and considered cured by a physician.

Patients also had access to a public discussion forum on the platform.

Among all participants, quarterly telephone interviews were conducted from baseline to month 24 so that the investigators could assess risk behaviors as well as HCV testing history.

Hochstatter and team used cox proportional hazards regression to evaluate whether participants in the intervention A-CHESS cohort were tested for HCV at a higher rate compared to the control cohort.

“To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment,” the investigators indicated.

Study Findings

In the participant population, 85.8% were non-Hispanic White and 54.8% were male participants. The mean age was 37 years.

Furthermore, 44.2% were HCV Ab positive and 25.5% were considered untested at baseline.

The team noted no significant difference in HCV testing uptake between the intervention and control cohort.

However, among 109 participants who engaged in injection drug use, those in the intervention group (n = 63) had a greater rate of HCV testing uptake compared with those in control group (89% vs 85%, respectively; hazard ratio [HR]: 1.34; 95% CI, 0.87-2.05; P = .18).

This trend was even more pronounced in the subset of 32 patients (23 intervention, 9 control) who reported sharing injections (87% intervention vs 56% control; HR, 2.92; 95% CI, 0.959-8.86; P = .06).

Perspectives

“An overall improvement in the HCV care continuum between baseline and month 24 was observed, where a smaller proportion of participants were untested and a higher proportion had tested HCV negative and achieved sustained virologic response,” wrote Hochstatter and colleagues.

“These trends appeared among both intervention and control participants, suggesting that there may be external factors influencing changes in the HCV care continuum,” they continued.

Nevertheless, the acknowledged that A-CHESS may be most useful in increasing testing rates among those with the highest risk of infection, as suggested by the findings.

They also indicated that higher powered studies are needed to detect differences in HCV testing among these highest-risk groups.

And, of course, evolving technologies can have widespread implications on healthcare screening and treatment practices.

“Advancements in mHealth technology offer the opportunity to provide information and services for the treatment of both opioid use disorder and HCV infection simultaneously,” the investigators wrote.

The study, “Effect of an mHealth Intervention on Hepatitis C Testing Uptake Among People With Opioid Use Disorder: Randomized Controlled Trial,” was published online at JMIR Publications.