Mobile telemedicine is associated with higher chances of initiating hepatitis C virus treatment in intravenous drug users with chronic hepatitis C

1. Mobile telemedicine was associated with significantly higher chances of initiating hepatitis C virus (HCV) treatment and achieving viral clearance compared to usual care in intravenous drug users living in rural areas with chronic HCV.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hepatitis C virus prevalence is as high as 60% in some parts of the rural United States among intravenous drug users. Unfortunately, harm reduction strategies such as syringe service programs are rare in rural areas. Studies have shown that timely, on-site, low-barrier HCV treatment is superior to referral in HCV care. Again, rural patients have limited access to these programs. The implementation of telemedicine in mobile harm-reduction strategies or HCV treatment can increase delivery to individuals who may otherwise be unable to use these services.

This 48-week open-label, randomized, parallel-group, superiority clinical trial was conducted across 3 rural counties in New Hampshire, USA and Vermont, USA, from April 2022 through January 2024. Participants included adults aged 18 years or older with a current or past history of drug injection, HCV infection, and no previous HCV treatment. Patients randomized to the enhanced usual care (EUC) group were referred to clinicians with care navigation. Patients randomized to the mobile telemedicine care (MTC) group received HCV direct-acting antiviral treatment through telemedicine, along with on-demand syringe services via van staff.

Overall, this study found participants in the MTC group were significantly more likely than EUC participants to initiate DAA treatment and achieve viral clearance. There was no significant difference in the prevalence of sharing syringes or other injection equipment. Future studies should seek to validate these results in larger populations.

Click here to read this study in JAMA Network Open

Relevant reading: Approaches to Offering Hepatitis C Treatment at Syringe Services Programs in the United States: A Scoping Review

In-Depth [randomized clinical trial]

Telemedicine may increase access to HCV harm reduction strategies and treatment among intravenous drug users living in rural areas. This randomized clinical trial investigated the efficacy of telemedicine for HCV treatment compared to enhanced usual care. The primary outcomes were the proportion of participants who (1) initiated DAA treatment for HCV, (2) achieved viral clearance at the 12-week follow-up, and (3) reported no injection equipment sharing at any point after the expected treatment completion visit.

150 patients were randomized in a 1:1 ratio to the EUC (mean [SD] age, 38.2 [9.1] years; 29.3% female) and MTC arms (mean [SD] age, 39.3 [9.1] years; 33.3% female). 57 (75.8%) of the MTC patients and 62 (82.7%) of the EUC patients had follow-up data. MTC patients had a significantly increased likelihood of DAA initiation compared to EUC patients (43 [57.3%] vs 20 [26.7%]; relative risk [RR], 2.15 [95% CI, 1.41-3.28]). Individuals in the MTC group were also significantly more likely to achieve viral clearance (28 [37.3%] vs 14 [18.7%]; RR, 2.00 [95% CI, 1.15-3.49]). At baseline, 20 MTC participants (26.7%) and 28 EUC participants (37.3%) reported recent sharing of syringes or other injection equipment. There was no significant difference in the change in equipment sharing between groups (RR, 0.95; 95% CI, 0.68-1.32).

Image: PD

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