High rates of intravenous drug users have hepatitis C. (Jeff J. Mitchell/Getty Images)
An Oregon study focused on rural residents found a promising method for eliminating hepatitis C, a common and potentially fatal disease that afflicts many drug users.
Hepatitis C is curable with medication that’s been on the market for about 10 years, but patients can go years without any symptoms and often don’t know they’re infected. Untreated, hepatitis C can advance to cirrhosis of the liver, liver failure and death.
Treating advanced stages of the disease is expensive and good outcomes are not certain. It’s much cheaper to treat people with a hepatitis C medication even though the drugs are expensive, said Dr. Andrew Seaman, an assistant professor of Oregon Health & Science University. He led a study in rural Oregon that found that using telemedicine and the support of peers who’ve recovered from drug addiction leads to a high cure rate for hepatitis C among drug users who otherwise might not even get tested.
“We have life-saving medications to treat hepatitis C,” Seaman said. “This study shows that finding unique ways to improve access to treatment — beyond traditional health care settings — is crucial for supporting people who use drugs.”
The virus is transmitted through blood — it’s the most common blood-borne disease in the U.S. — and can easily spread among people who share needles.
Health officials estimate that 2.4 million people in the U.S. have hepatitis C and many use drugs. In Oregon, about 2,900 people suffered from acute or chronic hepatitis C last year, according to state data, and a high rate of people died.
“We have the third highest mortality associated with hepatitis C in the country, and the fourth highest prevalence of hepatitis C in the country,” Seaman said.
Previous studies have centered in urban areas where health care providers are relatively easy to access and where the stigma to seek treatment might be lower than in rural towns where people often know each other. Few researchers have studied curing patients in rural areas, though studies show that’s where severe infection rates are the highest.
Seaman’s study, published in the journal Clinical Infectious Diseases, was conducted between July 2020 and December 2022 in seven counties: Coos, Curry, Douglas, Jackson, Josephine, Lane and Umatilla. He picked them because they have high rates of hepatitis C and high rates of drug overdoses. To choose participants, researchers screened people for hepatitis C and either recent intravenous drug use or illegal opioid use. A total of 203 who qualified were enrolled in the study and divided into two groups.
Both groups involved the use of peers, who generally have an easier time building trust with drug users because they know what it’s like to be addicted to drugs and have struggled to reach recovery.
But the groups varied in their treatment method. In one group, peers referred the participants to a local provider and gave them information about how to obtain a prescription for a hepatitis drug. The peers also referred the participant to a local managed care organization to get insurance coverage.
The other group used telemedicine visits with OHSU providers, and the peers were much more involved in treatment. They helped the participants get enrolled in insurance and facilitated the telemedicine visits, including supplying a phone, laptop or tablet. They also delivered medication and followed up to make sure the participant stayed on the weeks-long treatment, including people who were homeless or didn’t have a phone. They offered harm reduction tools as well, such as overdose reversal drugs, and linked participants to addiction treatment and temporary housing.
That extra involvement by the peers — and the use of telemedicine which brings the provider to the patient through a video link — had a dramatic effect on the results, the study found. Those in the telehealth group who had added help from peers were about seven times more likely to be treated for hepatitis C and four times more likely to eliminate the virus from their system after six months. Nearly 70% of those in the telehealth group were cured.
“This is one of those rare situations where spending money will actually save money,” Seaman said. “Hepatitis C causes liver cancer, loss of productivity, diabetes and all kinds of complications that cost lives and money. And it’s transmissible, so every time a patient is cured, we also prevent multiple transmissions to other people.”
He believes the study is the first to evaluate the use of telehealth in rural areas with high rates of hepatitis C and the first to look at peer-assisted telemedicine. Seaman said they’re a valuable resource who offer a big opportunity for health care.
“I think of peers as having a Ph.D. in living with substance use disorders,” Seaman said. “We have a lot of people coming out and in recovery and honestly there’s not a huge amount of training required.”
Seaman and another addiction specialist at OHSU, Dr. Todd Korthuis, said using telehealth and peers could be easily scaled to reach a large number of people infected with hepatitis C or another virus like HIV.
“This study teaches us that local peers in rural communities can deliver care directly to people who often slip through the cracks of our health care system,” Korthuis said.
GET THE MORNING HEADLINES.