Abstract
Background: Healthcare delivery was disrupted during the COVID-19 pandemic, requiring minimized in-person contact between patients and clinicians. During the pandemic, people with opioid use disorder (OUD) were not only at elevated risk for COVID-19, but had markedly reduced access to treatment for OUD, Hepatitis C virus (HCV) and HIV due to recommended decreased in-person visits.
Methods: From March 15-June 15, 2020 at the syringe services program (SSP) in New Haven, Connecticut, USA, a differentiated care model evolved with reduced clinical demands on people who inject drugs (PWID) to ensure screening and treatment for HCV, HIV and OUD, with a focus on HCV treatment. This model involved a single, bundled screening, evaluation, testing (SET) and monitoring strategy for all three conditions, minimal in-person visits, followed by tele-health communication between patients, outreach workers and clinicians. In-person visits occurred only during induction onto methadone and phlebotomy at baseline and phlebotomy 12 weeks post-treatment for HCV to measure sustained virological response (SVR). Patients received supportive texts/calls from outreach workers and clinicians.
Results: Overall, 66 actively injecting PWID, all with OUD, underwent bundled laboratory screening; 35 had chronic HCV infection. Participants were 40 years (mean), mostly white (N = 18) men (N = 28) and 12 were unstably housed. Two were lost to-follow-up and 2 were incarcerated, leaving 31 who started pan-genotypic direct-acting antivirals (DAAs). The mean time from referral to initial phlebotomy and initiation of DAAs was 6.9 and 9.9 days, respectively. Fourteen additional patients were newly started on buprenorphine and 6 started on methadone; three and four, respectively, were on treatment at baseline. Overall, 29 (93.5%) PWID who initiated DAAs achieved SVR; among unstably housed persons the SVR was 83.3%.
Conclusions: In response to COVID-19, an innovative differentiated care model for PWID at an SSP evolved that included successful co-treatment for HCV, HIV and OUD using a client-centered approach that reduces treatment demands on patients yet supports ongoing access to evidence-based treatments.
Keywords: COVID-19; Differentiated care models; HCV treatment; Implementation science; Medications for opioid use disorder (MOUD); People who inject drugs (PWID); Syringe services programs.
【저자키워드】 COVID-19, Differentiated care models, HCV treatment, Implementation science, Medications for opioid use disorder (MOUD), People who inject drugs (PWID), Syringe services programs., 【초록키워드】 Treatment, HIV, pandemic, COVID-19 pandemic, Infection, risk, drug, medications, virus, HCV, opioid, Methadone, Buprenorphine, Laboratory, hepatitis C virus, Patient, hepatitis C, Referral, Connecticut, USA, Care, patients, Contact, followed by, access to treatment, Support, Clinicians, participant, disorder, phlebotomy, virological response, men, approach, incarcerated, direct-acting antiviral, initial, occurred, involved, elevated, reduced, initiated, reduce, conditions, sustained, New, baseline, SET, Syringe, 【제목키워드】 drug, virus, Patient, medication, disorder,