University of Massachusetts Chan Medical School, Worcester, MA, United States.
Northwestern Memorial Hospital, Chicago, IL, United States.
J Med Internet Res. 2023 Jun 2;25:e38176. doi: 10.2196/38176.
Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV.
This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology.
Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data.
Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences.
VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required.
直接作用抗病毒药物有可能消除注射毒品人群中的丙型肝炎病毒 (HCV) 流行；然而，不依从仍是一个障碍。直接观察治疗 (DOT) 是优化依从性的有效策略，已在阿片类药物治疗计划中频繁实施，但由于每日就诊的繁重负担，在社区卫生环境中实施较少。另一种方法是视频观察治疗 (VOT)，它使用移动健康技术来监测依从性。VOT 在丙型肝炎病毒感染的注射毒品者中尚未得到广泛研究。
这项定性研究是更大实施评估的一部分，调查了利益相关者对 Project HERO（丙型肝炎真实结果）中 VOT 的看法和经验，这是一项测试针对丙型肝炎病毒感染的注射毒品者的治疗提供模型的多地点实用试验。我们的目标是了解 VOT 技术实施的潜在障碍和促进因素。
对 27 名 Project HERO 研究人员和 7 名患者进行了定性访谈。访谈重点是对 VOT 应用程序的看法和经验，以及实施的障碍和促进因素。项目前 2 年的团队会议记录被转录。开发了一个编码系统并应用于数据。我们总结了主题数据，并将参与者的看法进行比较，以生成对数据的深入理解。
VOT 的常见障碍包括机械故障、手机被盗或丢失以及参与者和研究人员的陡峭学习曲线。在参与者年龄较大且技术技能较低的地点，工作人员发现难以实施 VOT 应用程序。研究人员发现，对应用程序使用情况的常规监测导致与参与者更紧密的互动。这既是这个实用试验的一个优势，也是对其有效性的潜在威胁。患者参与者报告了不同的体验。
对于某些患者，VOT 可能是 DOT 的有用替代方法，但并非对所有患者都可行。可能需要大量的员工参与。
