Facilitated telemedicine has emerged as a key player in the fight against hepatitis C virus (HCV) by effectively bridging geographical and temporal barriers. The study, a prospective, cluster-randomized clinical trial conducted across twelve opioid treatment programs in New York State, sheds light on the potential of this innovative approach.
Furthermore, the intention-to-treat cure percentages were remarkably higher in the telemedicine group (90.3% vs. 39.4% in the referral group). Statistical analysis revealed an estimated logarithmic odds ratio of 2.9 (95% CI, 2.0-3.5; P < .001). Subgroup analyses yielded no significant differences, emphasizing the broad applicability of facilitated telemedicine across various demographics and clinical conditions. Notably, illicit drug use decreased significantly among cured participants in both groups, pointing toward broader health benefits beyond HCV treatment.
Researcher on this study, Andrew H. Talal MD, MPH, an expert on diagnosing and treating liver disease, including HCV, especially in hard-to-treat populations, offers insights into his study’s results.
“The key factors for driving the difference in outcomes is that facilitated telemedicine permits almost instantaneous linkage-to-care. Underserved populations, such as people who use drugs, require innovative approaches to be linked-to-care in a timely manner. Future research should evaluate the settings and diagnoses where facilitated telemedicine might be most appropriate. A facilitated model might also be appropriate for clinical management of diseases through telemedicine,” explains Talal.
Main Takeaways
- The study demonstrates that facilitated telemedicine, integrated into opioid treatment programs, significantly improves access to hepatitis C treatment, resulting in higher initiation rates and superior cure percentages compared to conventional off-site referral systems.
- There is a difference in intention-to-treat cure percentages between the telemedicine, and the referral group, with 90.3% versus 39.4% respectively.
- Beyond the primary goal of HCV treatment, the study reveals additional health benefits associated with facilitated telemedicine.
The trial enrolled 602 HCV-infected individuals between March 1, 2017, and February 29, 2020. The primary aim was to compare sustained virologic responses for HCV among persons with opioid use disorder, exploring the efficacy of facilitated telemedicine integrated into opioid treatment programs against the conventional off-site hepatitis specialist referral system.
Participants were divided into 2 groups: 1 receiving treatment via facilitated telemedicine (n=290) and the other through standard off-site referral (n=312). The results were striking: 92.4% of participants in the telemedicine group initiated treatment compared to only 40.4% in the referral group.
Importantly, minimal reinfections occurred, with a hepatitis C virus reinfection incidence of 2.5 per 100 person-years, further supporting the efficacy of the telemedicine approach. Participant satisfaction with healthcare delivery was consistently high across both groups, highlighting the acceptability and feasibility of this model.
“Facilitated telemedicine integrated into opioid treatment programs (OTPs) helps overcome geographic and temporal barriers in accessing hepatitis C treatment by removing transportation and travel time considerations as well as reducing wait times,” according to Talal. “Our participants attended OTPs frequently, often daily, permitting co-dispensing of methadone and HCV medications. The specific features that made telemedicine effective were the aspects of facilitation and the fact that a case manager facilitated the entire telemedicine encounter. The case manager was also an advocate and educator for their patients. Phlebotomy was available on site in the majority of OTP along with support services.”
In conclusion, the integration of facilitated telemedicine into opioid treatment programs represents a promising strategy for enhancing HCV elimination efforts. This study demonstrates superior cure rates and underscores telemedicine's potential to overcome geographic and temporal barriers, ultimately advancing public health initiatives in combating HCV infection.
Reference
Tala A, Markatou M, Liu A, et. al. Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine. JAMA Network. Published April 3, 2024. Accessed May 22, 2024.https://jamanetwork.com/journals/jama/article-abstract/2816706
