Speaker

Thomas J. Stopka, PhD, MHS
Professor
Department of Public Health and Community Medicine
Tufts University School of Medicine

Slides Coming Soon

Keywords

Harm Reduction; Rural Population; Mobile Van; Substance Use; Opioid Use; PWID; Hepatitis C; HIV

Key Points

• The DISCERNNE trial was 1 of 8 studies funded as part of the Rural Opioid Initiative (ROI). In the UG3 phase, the research team identified a high risk of HIV outbreak for people who inject drugs (PWID) in the Northeastern U.S. due to high Hepatitis C virus (HCV) rates and a lack of harm reduction services (i.e., injection equipment and HCV testing and treatment).

• The UH3 phase sought to implement sustainable, locally tailored interventions from 2020 to 2024. They compared mobile telemedicine care (MTC) with integrated syringe services to enhanced usual care (EUC) referral to a local or regional provider. They hypothesized that the former intervention would be associated with more HCV treatment initiation, higher sustained virologic response 12 weeks after treatment, and less syringe sharing.

• PWID who were offered testing and treatment via MTC were twice as likely to both start HCV treatment and achieve higher sustained virologic response than PWID who were referred to EUC. However, cure rates were only about 60% in either group.

• Mobile telemedicine effectively links people with active opioid use disorder to treatment, but treatment interruptions remain common. Barriers include a lack of phones; difficulty with medication management and storage; and incarceration. Additionally, this population requires a significant amount of support to initiate and complete treatment and avoid reinfection, and there remains a need for innovative, intensive approaches to HCV care management.

Discussion Themes

Community partnerships were crucial to the research team’s success, enabling effective harm reduction services and providing consistent parking locations for the mobile unit to support participant recruitment and engagement. The team built trust with the community by hiring staff with lived experience and harm reduction expertise who employed non-judgmental, flexible approaches.

Overcoming challenges with transportation and communication required a flexible approach, combining a consistent van parking schedule with mobility to meet participants where they were. Staff used social media, reached out to friends and family, and went into the field on foot to locate participants.

Dr. Stopka suggested that future interventions be even more mobile, potentially utilizing backpacks, bikes, or scooters to reach the most isolated members of a community.