“I really can’t imagine anything that could’ve been more easy”: patient perspectives on low-threshold peer-facilitated telemedicine hepatitis C treatment for people who use drugs

Abstract Background Injection drug use among nonurban people has fueled sharp rises in Hepatitis C (HCV) infections. Innovative treatment models are needed that circumvent healthcare system barriers for people who use drugs (PWUD), particularly in rural areas. The Oregon HOPE TeleHCV study randomized PWUD living with HCV in rural Oregon to peer-facilitated and streamlined telemedicine HCV treatment (Peer TeleHCV) versus enhanced usual care (EUC) and assessed sustained virologic response at 12 weeks post treatment (SVR12). Peer Support Specialists (peers) conducted HCV screening in the community, facilitated pretreatment evaluation and linkage to telemedicine HCV treatment clinicians, and supported participants in HCV medication adherence. A qualitative investigation queried patients about their experiences with the implementation of the model. Methods This qualitative study explored patient experiences with the Peer TeleHCV model in rural Oregon. We conducted semi-structured interviews with 34 participants purposively sampled from a larger randomized trial comparing Peer TeleHCV with enhanced usual care. The qualitative team analyzed transcripts using a thematic analysis framework combining inductive and deductive coding.Results. Participants described the model as accessible, supportive, and low barrier. We identified three major themes: 1) Staff approach and values facilitated engagement in care; 2) Convenience and flexibility made care accessible, and 3) Support addressing needs helped overcome barriers to care. Conclusion Findings highlight how community-based peers, integrated telemedicine, and flexible model design together reduce structural barriers to HCV care for rural PWUD. Adapting peer-facilitated telemedicine models can inform broader implementation of low-threshold, equitable approaches for substance use disorders and infectious disease treatment.