Telehealth for hepatitis C treatment during the pandemic: What works?

In 2021 the DruGS team conducted an Australian Government Department of Health-funded qualitative study on telehealth treatment for hepatitis C during the COVID-19 pandemic. The final report from the project has just been launched via webinar, and featured presentations on the findings and recommendations and a panel discussion spanning harm reduction and peer support, advocacy work, and healthcare practice.

In the launch, which was facilitated by Emily Lenton (Project Coordinator, BBV Program, ARCSHS, La Trobe University), Prof Suzanne Fraser (Principal Investigator and Director, ARCSHS, La Trobe University) introduced the project. We then featured presentations from Carrie Fowlie (CEO, Hepatitis Australia); Dr David Iser (Gastroenterologist, St Vincent’s Hospital/Scope Gastroenterology; Esha Leyden (Peer Harm Reduction Worker, QuIHN) discussing telehealth for hepatitis C from a policy and advocacy, practitioner, and peer perspective respectively, to provide context for the research. Dr Renae Fomiatti (Research Officer, ARCSHS, La Trobe University) and Dr Frances Shaw (Research Officer, ARCSHS, La Trobe University) presented the detail of the study, as well as its findings and recommendations, and in a discussion panel the presenters returned to respond to the findings.

In recent years, direct-acting antiretroviral (DAA) medications have made a significant difference to treatment for hepatitis C, with fewer side effects and higher success rates. In the context of Australia’s commitment to the World Health Organization’s goal of elimination by 2030, Australia is seeking ways to improve access and treatment uptake. Since the beginning of the COVID-19 pandemic, telehealth has helped facilitate access to essential primary health services beyond its existing use in regional and rural settings. In this context, more needs to be understood about the benefits and disadvantages of telehealth care, the barriers to accessing telehealth for people living with hepatitis C, and the support needs of healthcare practitioners using telehealth.

This qualitative interview-based project aimed to address these issues. During 2021, interviews were conducted with 40 patients and practitioners involved in treatment for hepatitis C. Overall, patients and practitioners found telehealth convenient and useful in accessing care, but also identified some limitations of telehealth. As research officer Frances Shaw explains:

While patients and practitioners saw telehealth as improving access to treatment, outcomes were not straightforward. Lack of organisational preparedness and limited support meant it was not always easy to access or reliable to use. Telehealth also had the potential to lessen stigma, but participants also said that telehealth could be a bit impersonal and sometimes encouraged very short consultations. We found this could sometimes lead to less communicative or caring healthcare encounters.

Recommendations based on the study findings can be found in the report. They include involving peer advocates and harm reduction workers in the design and delivery of telehealth models of care, additional messaging and health promotion to ensure people are aware of telehealth availability, measures to support relationship-building in telehealth settings, and support measures to increase access to video telehealth where it would be beneficial.

The webinar recording will be of interest to researchers and professionals working in policy, health, and consumer advocacy, as well as healthcare practitioners implementing telehealth.

About the presenters

Emily Lenton is a Research and Project Officer at the Australian Research Centre in Sex, Health and Society, La Trobe University, working on qualitative projects that seek to improve the lives of people affected by hepatitis C. Emily has worked extensively in research, workforce development and health promotion relating to blood-borne viruses.

Professor Suzanne Fraser is Director of the Australian Research Centre in Sex, Health and Society, La Trobe University, and Visiting Professorial Fellow at the Centre for Social Research in Health at the University of New South Wales. Her research focuses on alcohol and other drug consumption, the body, gender, health and the self.

Carrie Fowlie is the CEO of Hepatitis Australia, the national peak body representing the state and territory hepatitis organisations and the interests of 350,000 Australians impacted by hepatitis B and hepatitis C. Carrie has two decades of peak body, policy and social justice experience. Her collaborative work has resulted in policy, programs and law reform consistent with the evidence and the priorities of her constituencies.

Dr David Iser is a Gastroenterologist and Hepatologist who consults broadly on disorders of the liver and gut. He is skilled in Endoscopy (Gastroscopy and Colonoscopy), PillCam and FibroScan. Dr Iser holds dual public hospital appointments in Melbourne at St Vincent’s Hospital and The Alfred and travels to Bairnsdale Hospital monthly. He also consults with and offers continuing care to remotely located patients requiring special access via the telehealth program.

Esha Leyden is a Peer Harm Reduction Worker at the Queensland Injectors Health Network. She provides support and education to people seeking information and help relating to hepatitis C and the safer use of injecting drugs. She has lived experience of hepatitis C, treatment, and injecting drugs, which allows her to have a strong understanding of the challenges faced by community, and their ongoing needs.

Dr Renae Fomiatti is a Research Officer at the Australian Research Centre in Sex, Health and Society, La Trobe University. She conducts qualitative research on alcohol and other drug use and recovery, health and gender. Her research is informed by contemporary feminist theory and Science and Technology Studies. She previously held an appointment at the National Drug Research Institute, Curtin University.

Dr Frances Shaw is a Research Officer at the Australian Research Centre in Sex, Health and Society, La Trobe University. She has an interdisciplinary background spanning media and cultural studies, political theory, women’s and gender studies, and sociology. Her most recent work has focused on the relationships between technology and health, digital health activism and advocacy, technology ethics, and digital healthcare.