In New England’s rural areas, the epidemic of opioid use disorder (OUD) and its related conditions:
overdose, HIV, hepatitis C virus (HCV), sexually transmitted infections (STIs) and other infectious
comorbidities present the most substantial challenges to public health and health care in decades. The Drug
Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study examined
the epidemiology of opioid use, its infectious consequences, and service accessibility in rural counties along
the Interstate 91 corridor in Massachusetts, New Hampshire and Vermont. Our initial work (UG3) found that
syringe-sharing and HCV are highly prevalent, while access to clean syringes, phlebotomy services, HCV
testing and treatment are limited placing these counties at high risk for a Scott County-like HIV outbreak. Other
relevant lessons learned from the UG3 phase include: (1) any intervention must limit the burden on the local
harm reduction and medical institutions that have limited space and resources for new programming and are
straining to meet their current responsibilities; and (2) any intervention must account for the reluctance of
active PWIDs to seek care from a health system that has treated them poorly.
In the second phase of the DISCERNNE study (UH3), we are working closely with harm reduction
experts in these rural communities to deploy a mobile syringe services van to expand HCV antibody and viral
testing, bolster syringe access, and provide HCV telemedicine treatment. Study participants with HCV antibody
present will undergo testing for HCV viremia, and, as appropriate, receive initial hepatitis B virus (HBV) and/or
hepatitis A virus (HAV) vaccines. Participants (n= 220) are randomized to one of two strategies for HCV
¿ Enhanced Usual Care (EUC) – referral with care navigation to an HCV treatment provider.
¿ Mobile tele-HCV Care (MTC) – telemedicine Direct-Acting Antiviral treatment for HCV (DAA) on the van.
If effective, this mobile model of HCV telehealth integrated with syringe services will provide a promising
approach for local public health authorities seeking to curb opioid injection, syringe sharing and HCV rates in
rural America, and reduce the risk environment for HIV outbreaks in those communities. An administrative
supplement is requested to offset an increase in project costs and challenges related to the Covid-19