Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region

Abstract

Background Hepatitis C virus (HCV) and the opioid epidemic disproportionately affect the Appalachian region. Geographic and financial barriers prevent access to specialty care. Interventions are needed to address the HCV-opioid syndemic in this region. Methods We developed an innovative, collaborative telehealth model in Southwest Virginia featuring bidirectional referrals from and to comprehensive harm reduction (CHR) programs and office-based opioid therapy (OBOT), as well as workforce development through local provider training in HCV management. We aimed to (1) describe the implementation process of provider training and (2) assess the effectiveness of the telehealth model by monitoring patient outcomes in the first year. Results The provider training model moved from a graduated autonomy model with direct specialist supervision to a 1-day workshop with parallel tracks for providers and support staff followed by monthly case conferences. Forty-four providers and support staff attended training. Eight providers have begun treating independently. For the telehealth component, 123 people were referred, with 62% referred from partner OBOT or CHR sites; 103 (84%) attended a visit, 93 (76%) completed the treatment course, and 61 (50%) have achieved sustained virologic response. Rates of sustained virologic response did not differ by receipt of treatment for opioid use disorder. Conclusions Providers demonstrated a preference for an in-person training workshop, though further investigation is needed to determine why only a minority of those trained have begun treating HCV independently. The interdisciplinary nature of this program led to efficient treatment of hepatitis C in a real-world population with a majority of patients referred from OBOTs and CHR programs.

Methamphetamines and Serious Injection-Related Infections: Opioid Use Care Continuum and Opportunities to End Alabama's Drug Crisis

“…Telehealth is one promising modality that can help expand addiction services via remote administration of addiction treatment [ 35 ]. Telehealth also has the potential to extend addiction services into rural and poor regions where many of our SIRI patients reside postdischarge [ 36 ]. For example, if a patient is not ready to enter recovery during their inpatient stay, having the option to utilize telehealth postdischarge and begin MOUDs when they are ready is invaluable.…”

Hepatitis C: Standard of Treatment and What to Do for Global Elimination

“…Pharmacists or non-specialist providers may also contribute directly to therapy monitoring either in a clinic or using telehealth systems [ 40 ]. Studies have demonstrated the improved adherence and better prevention of drug–drug interactions and medication errors with the involvement of support staff [ 41 , 42 ]. All patients who complete DAA therapy should be evaluated for SVR at least 12 weeks after completing therapy to confirm the efficacy of therapy and to determine the plan for subsequent clinical follow-up [ 18 , 19 ].…”

Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts

“…Prior studies have shown this to be achievable. 21,22,34,67,68,73,74 For example, a clinical trial in the Washington D.C. area found that patients treated by advanced practice providers or primary care providers given a short 3-hour training had similar treatment outcomes compared to specialists treating chronic HCV. 67 These findings underscore the point also demonstrated in several other studies: chronic HCV can be effectively treated by non-specialists.…”

“…67 These findings underscore the point also demonstrated in several other studies: chronic HCV can be effectively treated by non-specialists. 66,71,[73][74][75] To help providers who have not traditionally treated HCV gain more experience, tele-mentoring programs (i.e., Project ECHO® in the U.S.) can be utilized; these programs have been launched worldwide, in places such as Australia, Rwanda, and India. 48,69,[76][77][78][79] These tele-mentoring programs increase primary care provider capabilities and confidence in treating HCV, which leads to more patients being cured of HCV.…”