Long-Term Benefits Following Hepatitis C Cure Through Facilitated Telemedicine; Experiences of People With Opioid use Disorder Five Years After Achieving a Sustained Virological Response

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2025-09-24 DOI:10.1111/hex.70404

Zoi Papalamprakopoulou, Tin H. Dang, Christopher J. Gonzalez, Colin J. Tedesco, Paul F. Updike, Christina Corl, Arpan Dharia, Noelia Hernandez, Martin F. Shapiro, Elaine Wethington, Andrew H. Talal

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Abstract

Background

Facilitated telemedicine is highly effective for hepatitis C virus (HCV) treatment among people with opioid use disorder (OUD). However, the long-term impact of sustained virological response (SVR) through this model of treatment remains unexplored. We examined how people with OUD perceive SVR achieved through facilitated telemedicine.

Methods

We conducted two focus group discussions (FGDs) with nine participants at least 5 years post-SVR through a randomised controlled trial of facilitated telemedicine in opioid treatment programmes (OTPs) (New York State, 2018–2020). Eligibility required active OTP enrolment at the time of FGDs. We used a semi-structured interview guide and performed thematic analysis of FGD transcripts.

Results

Participants had a mean age of 52.6 years (SD = 13.7), 66.6% were male, and 88.8% identified as White. We identified three FGD themes, each corresponding to pre-, during and post-intervention phases (see Figure 1): (1) Attitudes towards HCV and barriers to treatment among people with OUD, (2) Embracing facilitated telemedicine for HCV care integrated into OTPs, and (3) Experiencing long-term benefits from facilitated telemedicine across all aspects of HCV care and overall well-being. Barriers included competing priorities, perceiving HCV treatment as a low priority, and insurance restrictions (Theme 1). Participants valued facilitated telemedicine for its convenience, empathetic clinicians, and one-stop shop approach (Theme 2). At least 5 years post-SVR, participants reported benefits in HCV knowledge, improved OUD recovery, and improvement in whole health (Theme 3).

Conclusion

At least 5 years post-SVR, people with OUD reported improvements in OUD recovery, overall well-being and sustained satisfaction with telemedicine-based HCV care. These findings highlight the lasting impact of both an SVR and care delivery through facilitated telemedicine.

Patient and Public Contribution

In this study of patient involvement, we conducted focus groups with patient-participants to examine the long-term impact of receiving HCV care through facilitated telemedicine integrated into OTPs. Participants had previously taken part in a randomised controlled trial of facilitated telemedicine (New York State, 2018–2020). At least 5 years after achieving an SVR, we sought participant feedback to evaluate the long-term impact and sustainability of facilitated telemedicine as an approach to achieve an HCV cure with the objective of informing future policy development. Participants had also contributed critical input at various stages of the original study's design and implementation. During the pilot phase, participants advocated for facilitated telemedicine in a testimonial video. Participants provided feedback on design and implementation by participating in planning and site initiation meetings. A Patient Advisory Committee ensured participant voices were integrated into the research process by representing their feedback on study conduct. Additionally, a Sustainability Committee supported public involvement by promoting educational opportunities, providing input on implementation, and addressing long-term sustainability considerations.

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通过便利的远程医疗治疗丙型肝炎的长期效益阿片类药物使用障碍患者在获得持续病毒学应答后5年的经历

背景：便利的远程医疗对阿片类药物使用障碍（OUD）患者的丙型肝炎病毒（HCV）治疗非常有效。然而，通过这种治疗模式的持续病毒学反应（SVR）的长期影响仍未得到探索。我们研究了OUD患者如何感知通过便利的远程医疗实现的SVR。方法：我们通过一项阿片类药物治疗方案（OTPs）中便利远程医疗的随机对照试验（纽约州，2018-2020），在svr后至少5年对9名参与者进行了两次焦点小组讨论（fgd）。资格要求在发展补助金时积极参加OTP。我们使用了半结构化的访谈指南，并对FGD文本进行了专题分析。结果：参与者平均年龄为52.6岁（SD = 13.7）， 66.6%为男性，88.8%为白人。我们确定了三个FGD主题，每个主题对应于干预前、干预期间和干预后的阶段（见图1）：(1)对HCV的态度和OUD患者的治疗障碍；(2)将HCV护理纳入otp的便利远程医疗；(3)在HCV护理和整体健康的各个方面体验便利远程医疗的长期效益。障碍包括优先事项的竞争，将丙型肝炎病毒治疗视为低优先级，以及保险限制（主题1）。与会者重视便利的远程医疗，因为它的便利性、移情临床医生和一站式服务方法（主题2）。svr后至少5年，参与者报告在HCV知识、改善OUD恢复和整体健康方面获益（主题3）。结论：svr后至少5年，OUD患者报告在OUD恢复、总体幸福感和基于远程医疗的HCV护理的持续满意度方面有所改善。这些发现强调了SVR和通过便利的远程医疗提供护理的持久影响。患者和公众的贡献：在这项患者参与的研究中，我们对患者参与者进行了焦点小组，以检查通过将便利的远程医疗整合到otp中接受HCV治疗的长期影响。参与者之前参加了一项便利远程医疗的随机对照试验（纽约州，2018-2020年）。在实现SVR至少5年后，我们寻求参与者反馈，以评估便利远程医疗作为实现HCV治愈的一种方法的长期影响和可持续性，目的是为未来的政策制定提供信息。参与者还在原始研究的设计和实施的各个阶段提供了重要的投入。在试点阶段，参与者在一个推荐视频中倡导便利的远程医疗。参与者通过参与规划和场地启动会议，对设计和实施提供反馈。患者咨询委员会通过代表他们对研究行为的反馈，确保参与者的声音被纳入研究过程。此外，可持续发展委员会通过促进教育机会、提供实施意见和解决长期可持续发展问题，支持公众参与。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.