TY  - JOUR
AU  - Karasz, Alison
AU  - Merchant, Krupa
AU  - Arnsten, Julia
AU  - Feinberg, Judith
AU  - Kim, Arthur Y
AU  - Lum, Paula J
AU  - McKee, Melissa Diane
AU  - Mehta, Shruti H
AU  - Meissner, Paul
AU  - Norton, Brianna L
AU  - Page, Kimberly
AU  - Pericot-Valverde, Irene
AU  - Singh, Reena
AU  - Stein, Ellen
AU  - Taylor, Lynn E
AU  - Tsui, Judith I
AU  - Wagner, Katherine
AU  - Litwin, Alain
PY  - 2023
DA  - 2023/6/2
TI  - A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences
JO  - J Med Internet Res
SP  - e38176
VL  - 25
KW  - mHealth
KW  - video-observed therapy
KW  - directly observed treatment
KW  - hepatitis C virus
KW  - persons who inject drugs
KW  - antiviral
KW  - adherence
KW  - HCV
KW  - opioid treatment
KW  - mobile health
KW  - adherence behavior
KW  - behavior intervention
KW  - telemedicine
KW  - digital health
KW  - perception
KW  - therapy
KW  - treatment
AB  - Background: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required. 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e38176
UR  - https://doi.org/10.2196/38176
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37266986
DO  - 10.2196/38176
ID  - info:doi/10.2196/38176
ER  -