A novel model of care; Telemedicine and peer support for HCV care among HIV-infected people who inject drugs in remote Myanmar: a retrospective study.

BACKGROUND: People who inject drugs (PWID) are at increased risk of co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Uncontrolled HCV infection contributes to ongoing transmission among PWID, underscoring the urgent need to expand access to treatment as a public health priority. Despite the availability of highly effective direct-acting antiviral therapy, access remains limited, particularly in remote areas where stigma and structural barriers complicate care delivery. Implementing integrated and differentiated HCV care models in these settings may help address this gap. This study evaluated a novel care model in remote areas in which general practitioners delivered integrated HCV and HIV care, supported by specialist telemonitoring, community health workers, and peer educators. We assessed treatment outcomes and associated predictors. METHODS: Routine program data from the HCV treatment register were used to assess treatment completion and sustained viral response (SVR) among PWID. SVR12 was defined as an undetectable HCV viral load at 12 weeks after treatment completion. Patients who achieved SVR12 were invited for retesting at one year to calculate the one-year SVR rate (SVR64). Logistic regression analyses were performed to identify predictors of both SVR12 and SVR64. RESULTS: Among 314 HIV-HCV co-infected PWID who initiated HCV treatment, 69.7% (219 of 314) achieved SVR12, and after one year, 57.5% (126 of 219) achieved SVR64, based on intention-to-treat analysis. Participants aged ≥ 25 years were significantly more likely to achieve both SVR12 and SVR64. Methadone maintenance therapy (aOR: 2.6; 95% CI: 1.5-4.4), not being an active PWID (aOR: 1.5; 95% CI: 1.0-2.5), and advanced liver disease: fibrosis (aOR: 2.3; 95% CI: 1.2-4.2) and cirrhosis (aOR: 2.9; 95% CI: 1.3-6.3), were independently associated with SVR64 (p ≤ 0.05). CONCLUSION: A novel care model involving general practitioners, specialist telemonitoring, and support from community health workers and peer educators demonstrated effectiveness in achieving SVR among HIV-HCV co-infected PWID in remote settings. Further qualitative research is warranted to better understand the factors influencing HCV treatment outcomes.