Implementation of integrated hepatitis C test and treat with peer support in opioid treatment programs: A qualitative RE-AIM evaluation of staff perspectives.

Abstract

People who use drugs (PWUD) have high rates of hepatitis C virus (HCV) infection and face significant barriers to HCV treatment uptake. HCV treatment integration into opioid treatment programs (OTPs) is associated with increased rates of HCV treatment uptake. Less is known about implementation outcomes of HCV treatment integration into OTP settings. The RAPID HCV study supported implementation of HCV test-and-treat with peer support at 5 OTPs in the United States and Canada. Qualitative interviews informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework were conducted with 21 staff members from 4 OTPs in Alabaster, Alabama, Baltimore, Maryland, and Toronto, Canada that implemented the RAPID HCV care integration model. Interviews were conducted between March 2023 and May 2024. Thematic analysis was utilized to explore implementation outcomes RESULTS: HCV care integration with peer support was perceived by OTP leadership and staff to be acceptable and appropriate, which served as a facilitator of adoption. Perceived fit of intervention components into OTP workflow varied by staff role. Support staff welcomed their role in providing HCV education and HCV care facilitation within the OTP context. OTP clinical staff and leadership noted increased clinical responsibilities and administrative tasks related to HCV evaluation and treatment, which limited perceived feasibility and probable maintenance of HCV care integration. HCV care integration into OTPs, although viewed as acceptable and appropriate by OTP staff, will require policy changes to provide additional resources and remove barriers, such as HCV treatment prior authorization requirements, to increase feasibility and maintenance.