Treatment of Hepatitis C virus among people who inject drugs at a syringe service program during the COVID-19 response: The potential role of telehealth, medications for opioid use disorder and minimal demands on patients

Abstract

Background Healthcare delivery was disrupted during the COVID-19 pandemic, requiring minimized in-person contact between patients and clinicians. During the pandemic, people with opioid use disorder (OUD) were not only at elevated risk for COVID-19, but had markedly reduced access to treatment for OUD, Hepatitis C virus (HCV) and HIV due to recommended decreased in-person visits. Methods From March 15-June 15, 2020 at the syringe services program (SSP) in New Haven, Connecticut, USA, a differentiated care model evolved with reduced clinical demands on people who inject drugs (PWID) to ensure screening and treatment for HCV, HIV and OUD, with a focus on HCV treatment. This model involved a single, bundled screening, evaluation, testing (SET) and monitoring strategy for all three conditions, minimal in-person visits, followed by tele-health communication between patients, outreach workers and clinicians. In-person visits occurred only during induction onto methadone and phlebotomy at baseline and phlebotomy 12 weeks post-treatment for HCV to measure sustained virological response (SVR). Patients received supportive texts/calls from outreach workers and clinicians. Results Overall, 66 active PWID, all with OUD, underwent bundled laboratory screening; 35 had chronic HCV infection. Participants were 40 years (mean), mostly white (N=18) men (N=28) and 12 were unstably housed. Two were lost to-follow-up and 2 were incarcerated, leaving 31 who started pan-genotypic direct-acting antivirals (DAAs). The mean time from referral to initial phlebotomy and initiation of DAAs was 6.9 and 9.9 days, respectively. Fourteen additional patients were newly started on buprenorphine and 6 started on methadone; three and four, respectively, were on treatment at baseline. Overall, 29 (93.5%) PWID who initiated DAAs achieved SVR; among unstably housed persons the SVR was 83.3%. Conclusions In response to COVID-19, an innovative differentiated care model for PWID at an SSP evolved that included successful co-treatment for HCV, HIV and OUD using a client-centered approach that reduces treatment demands on patients yet supports ongoing access to evidence-based treatments.

Telemedicine Improves HCV Elimination among Italian People Who Use Drugs: An Innovative Therapeutic Model to Increase the Adherence to Treatment into Addiction Care Centers Evaluated before and during the COVID-19 Pandemic

“…Despite 49 patients having advanced liver disease, during the treatment no PWUDs required to access to hospital facilities or other in-person visits, beyond the first at the start of antiviral treatment. In a recent study of Sivakumar et al, conducted in New Haven, USA, during the early months of COVID-19 pandemic, 31 active injecting PWUDs have been treated with a simplified treatment algorithm consisting of minimal in-person visits during the service syringe program followed by telehealth communication, primarily telephone calls, between patients and practitioners or clinicians [ 28 ]. All patients in this study completed the treatment and 29 patients achieved the SVR12 (93.5%), confirming that, alongside the type of patients who need an enhanced in-person monitoring, many PWUDs are able to self-manage their care adequately.…”

The British HIV Association national clinical audit 2021: Management of HIV and hepatitis C coinfection

“…A preliminary result from an online survey conducted by WHO showed that 95% of those involved in the provision of HIV, hepatitis and sexually transmitted infection testing in 53 European countries reported a decrease in testing in March-May 2020 compared with the same period in the previous year [21]. However, such changes to services may also lead to alternative solutions in care delivery, for example through the combination of home testing and telehealth, multi-month prescribing of ART, and development of close relationships of health services with commercial companies and non-governmental organizations to support home delivery of medications [22][23][24][25].…”

Can Telemedicine Optimize the HCV Care Cascade in People Who Use Drugs? Features of an Innovative Decentralization Model and Comparison with Other Micro-Elimination Strategies

“…To our knowledge, only three other studies have evaluated the effectiveness of telemedicine in the setting of the HCV care cascade in the PWUDs population ( Table 1 ) [ 34 , 35 , 36 ].…”

“…During the COVID-19 pandemic, Sivakumar et al [ 36 ] evaluated a model of care of HCV-positive PWUDs patients based on telemedicine. This model included in-person visits only at time zero and twelve weeks after the end of the treatment in order to verify the virological response.…”