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Abstract Details
Facilitating engagement of persons with opioid use disorder in treatment for hepatitis C virus infection via telemedicine: Stories of onsite case managers
Andrew H Talal1, Urmo Jaanimägi2, Kathleen Davis3, Jordan Bailey4, Barbara M Bauer2, Arpan Dharia2, Saliyah George5, Anthony McLeod4, Karen Morton6, Ann Nugent5, Marija Zeremski6, Amreen Dinani5, Don C Des Jarlais7, Ponni V Perumalswami8, Jonathan N Tobin6, Suzanne S Dickerson9
Author information
1Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, United States of America. Electronic address: ahtalal@buffalo.edu.
2Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, United States of America.
3Department of Psychiatry, University of Rochester, Rochester, NY, United States of America.
4START Treatment & Recovery Centers, Brooklyn, NY, United States of America.
5Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
6Clinical Directors Network (CDN), New York, NY, United States of America.
7School of Global Public Health, New York University, New York, NY, United States of America.
8Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America.
9School of Nursing, University at Buffalo, Buffalo, NY 14203, United States of America.
Abstract
Although hepatitis C virus (HCV) infection has high prevalence and incidence in persons with opioid use disorder (PWOUD), their engagement in HCV care has been limited due to a variety of factors. In an ongoing multisite study at 12 opioid treatment programs (OTPs) throughout New York State (NYS), we have been evaluating telemedicine accompanied by onsite administration of direct acting antiviral (DAA) medications compared with usual care including offsite referral to a liver specialist for HCV management. Each site has a case manager (CM) who is responsible for all study-related activities including participant recruitment, facilitating telemedicine interactions, retention in care, and data collection. Our overall objective is to analyze CM experiences of clients' stories and events to understand how the telemedicine model facilitates HCV treatment. Hermeneutic phenomenology was used to interpret and to explicate common meanings and shared practices of the phenomena of case management, and a focus group with CMs was conducted to reinforce and expand on key themes identified from the CMs' stories. We identified three themes: (1) building trust, (2) identification of multiple competing priorities, and (3) development of personalized care approaches. Our results illustrate that trust is a fundamental pillar on which the telemedicine system can be based. Participants' experiences at the OTP can reinforce trust. Understanding the specific competing priorities and routinizing dedicated personalized approaches to overcome them are key to increasing participation in HCV care among PWOUD.