Hepatitis C virus (HCV) infection is a major public health problem in the United States, worsened by injection drug use and the opioid crisis. Between 2013 and 2016, almost 2.4 million Americans, or 1% of the population, were living with the injection. Fortunately, new and very successful therapies called direct-acting antiviral agents (DAAs) have been broadly approved to treat HCV infection. Treatment with DAAs have demonstrated high cure rates — measured as sustained virologic responses (SVR) — for even difficult-to-treat groups like solid organ transplant recipients and patients with advanced liver disease. 

Unfortunately, people who inject drugs (PWIDs) frequently do not receive these highly successful treatments. DAA regimens are lengthy and complex, so health care providers may not offer HCV treatment for fear of non-adherence, re-infection, and drug resistance if a patient still actively uses drugs. Health system responses are also inadequate: venues for and providers of HCV treatment are still limited, even when patients are ready to seek treatment. PWIDs constitute the majority of people with HCV-infection, and prevalence among PWIDs may be as high as 77%. In order for chronic HCV infection to be meaningfully reduced, new care models are needed that address the interlocking barriers of both providers’ concerns for patient adherence to treatment and patients’ unmet need for care. Pairing emocha’s mobile app technology for video Directly Observed Therapy (video DOT) with these groundbreaking therapies could radically scale-up HCV treatment.

Expanding Models of Care for Hepatitis C

The Hepatitis C Real Options (HERO) study, begun in 2015, was designed to compare two ways of delivering treatment for PWID: a patient navigation (PN) model and a modified directly observed therapy (mDOT) model. This randomized pragmatic trial assessed which treatment model achieved better rates of initiation, adherence, and SVR. The study also asked what model patients preferred in order to deliver increased and enhanced patient-centered care. In the PN arm, patients were educated and supported to take their medication. In the mDOT arm, patients were observed taking their medication using the emocha mobile app. Patients receiving DOT for HCV treatment have already been shown to achieve high SVR (98%), an estimate that was statistically comparable to group therapy and self-administered treatment, even when patients were also receiving treatment for opioid addiction. 

emocha Partner Leads HERO Study

Dr. Alain Litwin, Chief of Academics and Research in the Department of Medicine, Prisma Health and Professor of Medicine at the Clemson University School of Health Research, leads the HERO study. While participant follow-up to determine long-term SVR is still ongoing, Dr. Litwin and collaborators at the eight U.S. study sites just published details of the study’s design in Contemporary Clinical Trials. The study’s forthcoming results will yield important insights into the delivery of HCV care for patients who are actively injecting drugs, and where adjuncts to care like the emocha app secure medication adherence to meet the unique care needs of this critically under-served population.