Seaman Andrew, Cook Ryan, Leichtling Gillian, Herink Megan C, Gailey Tonhi, Cooper Joanna, Spencer Hunter C, Babiarz Jane, Fox Christopher, Thomas Ann, Leahy Judith M, Larsen Jessica E, Korthuis P Todd
Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University.
Comagine Health.
Clin Infect Dis. 2025 Mar 17;80(3):501-508. doi: 10.1093/cid/ciae520.
Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet <10% of PWUD in the United States access HCV treatment; access is especially limited in rural communities.
We randomized PWUD with HCV viremia and past 90-day injection drug or nonprescribed opioid use in 7 rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care [EUC]). Peers supported screening and pretreatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants. Generalized linear models estimated group differences in HCV viral clearance (primary outcome) and HCV treatment initiation and completion (secondary outcomes).
Of the 203 randomized participants (100 TeleHCV, 103 EUC), most were male (62%), White (88%), with recent houselessness (70%), and used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five of 100 TeleHCV participants (85%) initiated treatment versus 13 of 103 (12%) EUC participants (relative risk [RR], 6.7 [95% confidence interval {CI}, 4.0-11.3]; P < .001). Sixty-three of 100 (63%) TeleHCV participants versus 16 of 103 (16%) EUC participants achieved viral clearance 12 weeks after anticipated treatment completion date (RR, 4.1 [95% CI: 2.5-6.5]; P < .001).
The Peer TeleHCV treatment model substantially increased HCV treatment initiation and viral clearance compared to EUC. Replication in other rural and low-resource settings could further World Health Organization HCV elimination goals by expanding and decentralizing treatment access for PWUD. Clinical Trials Registration. NCT04798521.
丙型肝炎病毒（HCV）的消除需要治疗吸毒人员（PWUD），然而在美国，只有不到10%的吸毒人员能够获得HCV治疗；在农村社区，获得治疗的机会尤其有限。
我们将俄勒冈州7个农村县的HCV病毒血症患者以及过去90天内有注射吸毒或非处方使用阿片类药物情况的PWUD随机分为同伴辅助远程医疗HCV治疗组（TeleHCV）和同伴辅助转诊至当地医疗机构组（强化常规护理[EUC]）。同伴为所有参与者提供支持，进行筛查和治疗前实验室评估，并为TeleHCV参与者提供远程医疗就诊、药物配送和依从性方面的便利。广义线性模型估计了两组在HCV病毒清除率（主要结局）以及HCV治疗启动和完成情况（次要结局）方面的差异。
在203名随机分组的参与者中（100名TeleHCV组，103名EUC组），大多数为男性（62%），白人（88%），近期无家可归（70%），且在过去30天内使用过甲基苯丙胺（88%）或芬太尼/海洛因（58%）。100名TeleHCV参与者中有85名（85%）开始治疗，而103名EUC参与者中有13名（12%）开始治疗（相对风险[RR]，6.7[95%置信区间{CI}，4.0 - 11.3]；P <.001）。100名TeleHCV参与者中有63名（63%）在预期治疗完成日期后12周实现病毒清除，而103名EUC参与者中有16名（16%）实现病毒清除（RR，4.——[95%CI：2.5 - 6.5]；P <.001）。
与EUC相比，同伴TeleHCV治疗模式显著提高了HCV治疗的启动率和病毒清除率。在其他农村和资源匮乏地区推广该模式，可通过扩大和分散PWUD的治疗途径，进一步推动世界卫生组织的HCV消除目标。临床试验注册编号：NCT04798521。
