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 a heightened risk of co-infection with HIV and hepatitis C virus (HCV), which adversely affects health outcomes. Uncontrolled HCV can lead to increased transmission rates among PWID, highlighting the urgent need for improved access to treatment as a public health priority. Despite the availability of effective HCV treatments, access remains limited, particularly in remote areas, where stigma further complicates care. Implementing integrated and differentiated HCV care in these regions could help address this gap. This study evaluated a novel care model in remote settings, where general practitioners delivered integrated HCV-HIV care, telemonitored by specialists and supported by community health workers and peer educators. We evaluated treatment outcomes and associated predictors. Methods: We used routine program data from the HCV treatment register to assess treatment completion rates and sustained virologic response (SVR) among PWID. SVR was defined as an undetectable HCV viral load 12 weeks after treatment completion. Patients who achieved SVR were invited for retesting at one year to calculate the one-year SVR rate. Logistic regression analyses were performed to identify predictors of both SVR and one-year SVR. Results: Among 314 HIV-HCV co-infected PWID who initiated HCV treatment, 93.0% completed it, 96.2% had 12-week HCV-RNA results, and 77.9% achieved SVR. After one year, 67.7% (126 of 186) maintained SVR. Methadone maintenance therapy (aOR: 2.22; 95% CI: 1.09-4.55) and advanced liver disease—fibrosis (aOR: 2.33; 95% CI: 1.05-5.16) and cirrhosis (aOR: 3.21; 95% CI: 1.13-9.10)—were significantly linked to one-year SVR (p ≤ 0.05). Conclusion: A novel care model involving general practitioners, specialist telemonitoring, and support from community actors has shown effectiveness for most HIV-HCV co-infected PWIDs. However, further qualitative research is needed to enhance SVR rates and better understand the reasons behind incomplete follow-up.