Telemedicine at Syringe Access Programs May Address Barriers, Expand Access to HCV Treatment

Dorothy E Loy, MD, PhD

Credit: Dorothy E Loy on LinkedIn

Findings from a recent study suggest co-locating hepatitis C virus (HCV) treatment at syringe access programs could help reduce barriers to treatment among people who inject drugs, further alluding to expanded access with telemedicine-based treatment programs.¹

Results published in Open Forum Infectious Diseases also call attention to the need for additional attention to barriers impacting patients’ ability to participate in telemedicine appointments, highlighting a common lack of access to a phone and even less access to video capability.¹

As a bloodborne disease, HCV is especially prevalent among people who inject drugs due to the sharing of needles and any equipment used to prepare and inject drugs. Early diagnosis can prevent health problems resulting from infection and prevent transmission of the virus, underscoring the need for routine testing among people who may be at increased risk of infection. Accordingly, the World Health Organization recommends decentralized, integrated testing, care, and treatment in primary care, harm reduction services, and prison settings for the accessibility and convenience of patients.^2,3

“Better understanding of the barriers to HCV treatment among people who inject drugs and strategies to improve treatment rates are essential in combating the rising rate of HCV incidence in the United States,” Dorothy E Loy, MD, PhD, instructor of hospital medicine at the University of Colorado Anschutz Medical Campus, and colleagues wrote.¹

To inform the design and implementation of HCV treatment programs targeting people who inject drugs who utilize syringe access programs, investigators developed and administered a 31-question survey in consultation with Harm Reduction Action Center staff, Harm Reduction Action Center clients, and HCV treatment providers at the Public Health Institute at Denver Health. Survey domains included demographics, HCV testing history and treatment experiences, barriers and preferences for accessing general medical care, and specific details about optimizing HCV treatment success if offered at the syringe access program.¹

Investigators used convenience sampling to approach syringe access program clients for participation in the survey, which was administered on iPads using a secure, Health Insurance Portability and Accountability Act-compliant, web-based application during normal operating hours twice weekly in September 2021. All survey responses were entered anonymously, and participants were compensated for their time with a preactivated $15 Visa gift card.¹

A total of 171 SAP clients completed surveys, representing approximately 20% of the 797 unique individuals who received services at the Harm Reduction Action Center that month. The median age of respondents was 37 (interquartile range [IQR], 31–45) years, and most (82%) clients were male. Though 93% of respondents reported having health insurance, just 31% had a primary care provider and 74% experienced homelessness.¹

Current or prior HCV infection was reported by 89 (52%) respondents, of whom 50 had not completed treatment. Of these individuals, 13 sought treatment but were unable to get it and 37 had not attempted to get treatment, with the most commonly cited reasons being ongoing drug use, logistic barriers, and medical system barriers.¹

Of 79 syringe access program clients with known treatment history and a prior positive HCV test, investigators noted more people who reported having a primary care physician (63%) and permanent housing (75%) completed HCV treatment compared to those without (25% and 32%, respectively) (P = .0024 and P = .046, respectively).¹

Survey results showed 89% of clients with HCV reported they would be more likely to get treatment if they were able to do so at the syringe access program, and the rate was greater among people who reported reluctance to seek medical care in general (98% vs 77%; P = .011). Although in-person appointments were generally preferred as the first-choice modality (72%), 77% of respondents either agreed or strongly agreed they would be comfortable with a video appointment. However, just 60% reported access to a phone and only 48% had access to a phone with video capability.¹

“Telemedicine-based HCV treatment could be adopted by the population of people who inject drugs who use syringe access programs, though attention should be focused on details of the programmatic design to meet the needs of this historically underserved population,” investigators concluded.¹

References:

1. ^{Loy DE, Kamis K, Kanatser R, et al. Barriers to Hepatitis C Treatment and Interest in Telemedicine-Based Care Among Clients of a Syringe Access Program. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofae088}
2. ^{US Centers for Disease Control and Prevention. People Who Use or Inject Drugs and Viral Hepatitis. August 24, 2020. Accessed March 18, 2024. https://www.cdc.gov/hepatitis/populations/idu.htm}
3. ^{World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed March 18, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c}