JMIR Publications

ABSTRACT

Background:

The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of persons with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD is critical. A-CHESS is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medication-assisted treatment (MAT) to improve long-term recovery.

Objective:

We incorporated HCV content and functionality into A-CHESS to (1) to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and (2) determine whether incorporating HCV content and functionality into A-CHESS increases HCV screening.are receiving medication-assisted treatment (MAT) to improve long-term recovery.

Methods:

HCV intervention content, including dissemination of educational information, private messages tailored to individual’s stage of HCV care, and a public discussion forum, were implemented into the A-CHESS platform. Individuals with OUD were randomly assigned to receive MAT alone (control arm) or MAT + A-CHESS (experimental arm). Quarterly telephone interviews, conducted from baseline to month 24, assessed risk behaviors and HCV screening history. Binomial logistic regression was used to assess overall whether individuals who received A-CHESS were more likely to be tested for HCV after 24 months compared to those in the control arm. To assess the effect of A-CHESS on subsets of individuals at highest risk for HCV, additional analyses examined the effect of the intervention among individuals who injected drugs and shared injection equipment. A log-rank test was conducted to evaluate whether A-CHESS influenced how promptly individuals underwent HCV testing.

Results:

Between April 2016 and April 2020, 416 individuals with OUD were enrolled. Overall, 44% of the study population was HCV-antibody positive, 30% were HCV-antibody negative, and 25% were considered untested at baseline. At month 24 there was no difference in HCV testing uptake between intervention and control participants overall. Among the 121 individuals who injected drugs, 62 (90%) intervention participants received an HCV test, compared to 45 (87%) control. Those who received A-CHESS and injected drugs were 1.42 times more likely to be tested for HCV by month 24 than individuals in the control arm who injected drugs (P=.55). Among the 36 individuals who shared injection equipment, 21 (88%) intervention participants received an HCV test, compared to 8 (67%) control. Those who received A-CHESS and shared equipment were 4.07 times more likely to be tested for HCV by month 24 than individuals in the control arm who shared equipment (P=.13). Individuals who shared equipment and received A-CHESS also tended to undergo HCV testing sooner than those who shared equipment but did not receive A-CHESS (P=.14).

Conclusions:

Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high risk behaviors such as sharing contaminated injection equipment. Clinical Trial: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034