Theme: Clinical Research Year: 2024
Background: Hepatitis C (HCV) treatment for people who use drugs (PWUD) reduces injection drug use and injection equipment sharing, but the effect is unclear among rural PWUD who face heightened barriers to access harm reduction services. We examined changes in injection drug use and injection equipment sharing following HCV treatment in a randomized trial comparing peer-assisted telemedicine for HCV treatment (TeleHCV) versus peer-assisted usual care in rural PWUD. We hypothesize that TeleHCV reduces risky behaviors and peers facilitate this change.
Methods: Mixed-effects logistic regression described associations between both injection drug use and injection equipment sharing and randomized group, frequency of peer contact, HCV treatment initiation, HCV cure, and time. Outcomes were by self-report; injection equipment sharing included all components of the injection apparatus. Follow up was done 12 and 36 weeks after HCV treatment completion. To minimize inflation bias, we compared models including main effects plus interactions between exposure and time to models with main effects only, using a type-III likelihood ratio test, and only made further comparisons between groups at each timepoint if the test was significant.
Results: Injection drug use declined more over time in TeleHCV participants vs control at 12 weeks (odds ratio [OR] = 0.42, 95% CI 0.20-0.87) and 36 weeks (OR=0.48, 95% CI 0.21-1.08). Injection drug use decreased more with greater number of peer interactions, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 12 weeks (OR = 0.75, 95% CI 0.57-0.99). Similarly, injection equipment sharing decreased over time, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 36 weeks (OR = 0.08, 95% CI 0.01-0.97).
Conclusion: Peer-assisted telemedicine for HCV treatment decreases injection drug use and injection equipment sharing; peers contribute to this effect.
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