Theme: Models of Care Year: 2022
The COVID-19 pandemic has disrupted healthcare delivery. People with opioid use disorder
(OUD), at heightened risk for COVID-19, face challenges accessing OUD and hepatitis C virus
(HCV) treatment given reduced in-person visits. U.S. HCV treatment dropped by over 30% at
the pandemic’s start, and has not recovered.
Co-located HCV and methadone plus harm reduction (HR) facilitate prevention and cascade
to cure. Rhode Island (RI)’s only non-profit methadone maintenance program (MMP),
CODAC, started their embedded HCV clinic in 2014.
Description of model:
From March 1, 2020-February 28, 2022, our program adapted to loss of in-person HCV visits.
Already in place was the physician-nurse navigator-pharmacist team and single, universal,
opt-out blood draw upon MMP entry, repeated annually (HCV antibody with reflexive
RNA/genotype, HIV, hepatitis A/B, liver panel, CBC, creatinine, PT/INR, treponema) with
HCV clinical visits moved to telephone-health. On-treatment labs were stopped. A free HR
vending machine moved on-site. Challenges included MMP staff attrition and suspension of
on-site phlebotomy, requiring patients to access off-site laboratories for baseline and
sustained virological response (SVR) bloodwork.
Seventy-five patients initiated DAAs, mean age 42 (26-63 years), 28% female, 61% genotype
1, 28% genotype 3; 93% had public health insurance (88% Medicaid, 5% Medicare), 7%
private. Of DAA initiation visits, 89% were conducted via telephone, 11% in-person, per
patient choice and in accordance with an in-person HCV care option permitted towards the
end of the assessment period, with most choosing continued remote care. Modified intentto-treat SVR was 90% (36/40); 4 patients did not achieve SVR, 13 remain on-treatment or
await SVR 12 weeks post-end-of-treatment, 22 were lost to follow-up, with overall SVR 58%
At a co-located HCV/MMP/HR clinic, telephone contact enabled continued HCV treatment
under COVID-19. Patient inability to access telephones and off-site phlebotomy continue as
barriers to expanded capacity.
Disclosure of Interest Statement: Nothing to disclose.