Convenience, rapport and skill: effective rural hepatitis C treatment, qualitative findings from a mobile harm reduction-informed tele-medicine intervention in Northern New England, 2022–2024

People who inject drugs (PWID) are at high risk for acquiring and transmitting the hepatitis C virus (HCV). Access to HCV testing and treatment remains limited in rural communities. Mobile healthcare interventions are promising models to reach underserved populations like rural PWID. Understanding the characteristics of effective interventions to engage rural PWID in HCV care can guide design strategies for HCV treatment and elimination in rural areas. The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study randomized 150 participants with chronic HCV to examine Mobile Tele-HCV Care (MTC) versus Enhanced Usual Care (EUC). On-the-spot qualitative interviews (n = 34) were conducted with study participants, community providers, and study van staff to understand the context for protocol implementation. For this study, qualitative coding and thematic analyses identified the characteristics of successful HCV treatment engagement among PWID in rural areas. This successful HCV treatment engagement intervention with out-of-treatment rural PWID had three essential characteristics: convenience, effective rapport, and skilled staff. Convenience factors included dependable and easily accessible locations with drop-in availability that made it easy to make HCV treatment a priority. Rapport with participants through a harm reduction approach engendered respect for autonomy and tailoring the protocol to accommodate the complexities of daily life that PWID face. Skilled staff were flexible across multiple roles including on-site phlebotomy, a notable barrier to rural PWID obtaining HCV treatment, and were competent in caring for PWID. We identified salient characteristics that contributed to high trust and treatment adherence among a marginalized population of rural PWIDs. Tailored, flexible approaches and specialized skills are required to engage and retain PWID in rural areas. NCT05466331.