Facilitated telemedicine as a patient-centered, sociotechnical intervention to integrate hepatitis C treatment into opioid treatment programs and overcome the digital divide among underserved populations: Conference workshop thematic analysis (Preprint)
BACKGROUND People with opioid use disorder (OUD) have the highest rates of hepatitis C virus (HCV) infection. Despite the availability of curative HCV medication, people with OUD have limited healthcare access largely due to stigma. In a recent, pragmatic, randomized controlled trial (RCT), we compared a facilitated telemedicine intervention for HCV treatment integrated into opioid treatment programs to offsite referral. Facilitated telemedicine is bidirectional videoconferencing between a remote provider and a patient, supported by a case manager who facilitates the telemedicine encounter. In the RCT, we found that facilitated telemedicine overcame the digital divide, promoting access to digital technology, internet provision, and digital literacy. In this work, a multidisciplinary group of investigators, who directed the RCT, conducted a workshop entitled “Advancing Viral Hepatitis Screening and Treatment in Opioid Treatment Settings – Models & Resources”. We sought to disseminate knowledge of facilitated telemedicine at the American Association for Treatment of Opioid Dependence Conference in May 2024. OBJECTIVE We identified lessons learned to successfully overcome challenges of facilitated telemedicine implementation for HCV treatment integrated into opioid treatment programs. METHODS We partnered with the National Alliance of State & Territorial AIDS Directors in planning the workshop. The workshop consisted of seven presentations on topics related to facilitated telemedicine implementation. The workshop was recorded and transcribed by Zoom. The transcripts served as data for the thematic analysis. The transcripts were interpreted to elucidate overall meanings and nuances derived from each presentation. In an iterative process, preliminary findings were compared until consensus was reached. Preliminary findings were aggregated and coalesced into themes. Verbatim quotes from the workshop were highlighted to support the themes. RESULTS We developed three themes: (1) Patient-centered care promotes HCV treatment for underserved populations through facilitated telemedicine. Case managers leveraged the destigmatizing environment of the opioid treatment program to build trust with patients, promoting an HCV cure through facilitated telemedicine. (2) Sociotechnical approaches expand healthcare access for people with OUD. To be effective, facilitated telemedicine integrates two necessary components, a social aspect and a technical aspect. (3) Facilitated telemedicine supports pragmatic research emphasizing people with OUD. A patient advisory committee, peer pipeline, and learning lunches were permissive to overcoming the digital divide. Additional pragmatic trials of facilitated telemedicine are needed to assess sustainability and scaling considerations beyond methadone treatment programs. CONCLUSIONS Facilitated telemedicine incorporates both a technical and a social component. The technical component largely addresses geographical challenges while the social addresses temporal (i.e., care coordination) issues, promotes trust, and largely assuages patients’ concerns related to HCV treatment. The patient-centered, sociotechnical intervention can satisfactorily address the digital divide thereby increasing healthcare access. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT02933970