Peer Assisted Telemedicine for Health in Substance Users-Comprehensive Care (PATHS-CC) - To end the hepatitis C (HCV) epidemic, life-saving treatments must be delivered to those at the intersection of homelessness, substance use, and mental illness. PATHS-CC utilizes Oregon's innovative, tested peer-assisted telemedicine hepatitis C virus (HCV) treatment model offer same-day HCV testing, diagnosis, and treatment in six counties and same-day SUD, mental health, and HIV treatment in 20 of Oregon's 36 counties. Oregon consistently ranks among the highest in the nation for substance use disorders (SUD), mental health disorders, unmet treatment need, unsheltered homelessness, and HCV prevalence and mortality. The PATHS-CC areas of focus will be six high-need rural, urban, and suburban counties around the state. Peer specialists in the current network conduct outreach to engage people with high need who are disconnected from care. Among peer services participants in the past two years, 46% were unsheltered, 51% reported moderate to extreme mental health concerns, 47% had injected drugs in the past 30 days, and 34% had a substance-related emergency department visit in the past 6 months. Most participants were non-Hispanic (60%), White (63%), male (56%), and between the ages of 26-40 (41%). PATHS-CC leverages existing infrastructure, including a robust peer recovery support specialist network across varied geographic and demographic contexts, and a long-standing research-to-practice collaborative comprising OHSU researchers, state agency representatives, community-based organizations, and implementation partners. Our peer-assisted telemedicine HCV model provides key advantages: 1) reaches people who are outside of traditional systems of care, including people experiencing homelessness, 2) enables access in areas with limited local care and long waits for care, 3) provides on-demand access to telemedicine HCV clinical visits, and 4) pairs clinical care with peer support for retention, resolution of barriers to adherence and continuity, and linkage to other services. We propose funding same-day HCV/HIV testing and diagnosis and integrated behavioral health services to improve health for people impacted by homelessness, mental illness, substance use, and HCV throughout Oregon and provide insights on effective and scalable models for HCV elimination among heavily burdened communities. We propose to purchase devices used for same-day HCV diagnosis and standard-of-care testing for six clinical sites in urban and rural areas throughout the state. We will also expand clinical staff to provide same-day access to HCV treatment, HIV treatment and prevention, mental health treatment, and substance use disorder treatment via telemedicine with a statewide reach. Our goals are to: 1) Cure 51-100 participants with HCV per year with same-day treatment in six sites throughout Oregon. 2) Implement a statewide HIV prevention and treatment program. 3) Link 100 participants per year to same-day mental health telemedicine treatment, 4) Link 50 participants per year to same-day substance use disorder treatment, and 5) Facilitate transitions to local care providers in urban and rural areas. To reach Goal 1, our objectives are to: outreach to 50 new participants per month, provide navigation to 200 participants per year, screen 360 participants for HCV antibody per year, administer same-day HCV testing to 180 participants per year, initiate HCV treatment in 60 participants per year, and cure 85% of those who initiate treatment. To accomplish Goals 2-5, we set objectives related to volume of screenings, referrals to same-day telemedicine, and linkages to long term care providers. Our team's experience and statewide partnerships equips PATHS-CC to change the landscape of healthcare access for Oregonians at the intersection of homelessness, substance use, mental illness, and infectious diseases.
