Theme: Models of Care Year: 2023
Background:
People who use drugs (PWUD) are a priority population in efforts to achieve hepatitis C virus (HCV) elimination. Inpatient substance use treatment programs (ISUTPs) screen PWUD for HCV infection, yet often do not provide HCV treatment onsite. Telehealth may support access to HCV care and treatment for PWUD in these healthcare settings.
Description of model of care/intervention:
An innovative collaboration between the New York City Health Department, an outpatient primary care center offering HCV treatment expertise among PWUD via telehealth, and two ISUTPs combined resources to facilitate access to HCV care by: (1) Providing technical assistance to ISUTPs to create systems to identify currently admitted PWUD with HCV infection (i.e., positive HCV RNA test results); (2) Integrating HCV care and treatment into ISUTPs’ workflow to link patients to a primary care appointment via telehealth.
Effectiveness:
For Year 1 (May 2021–April 2022), 6727 people were admitted to the ISUPTs. HCV testing was performed for 6663 (99%) people. Of these, 845 (13%) had a positive HCV RNA test and 199/845 (24%) people had primary care appointments made; of these, 40 were referred to HCV telehealth services. Of these, 35 (88%) attended their first telehealth appointment, 14 (40%) began HCV treatment, and 12 (30%) completed treatment.
Conclusion and next steps:
This collaboration demonstrated the feasibility of integrating viral hepatitis services at ISUTPs for PWUD using telehealth. Although only 24% of PWUD with a positive HCV RNA test were linked to care, most referred to telehealth readily attended appointments. A lower proportion initiated treatment, highlighting an opportunity for improvement. To enhance linkage to care and treatment, a community health worker will join the team, to liaise between the ISUPTs and the primary care telehealth partner. Further evaluation of this approach might provide evidence for integrated health services at ISUTPs to support HCV elimination efforts in New York City.