By Ethan Covey
Integrating facilitated telemedicine for hepatitis C virus (HCV) treatment into existing opioid treatment programs (OTPs) can lead to significant benefits, including higher cure rates, decreased drug use and fewer reinfections compared with therapy involving off-site referrals.
The approach also may increase HCV treatment access for underserved populations (JAMA 2024;331[16]:1369-1378).
“We understood that a critical approach to addressing HCV in people with opioid use disorder is to integrate treatment into places that they already frequent, namely opioid treatment programs,” said Andrew H. Talal, MD, a professor in the Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, in New York. “We used virtual integration, through telemedicine, to bring the hepatitis specialist to the OTP.”
The prospective, cluster-randomized clinical trial focused on 12 programs located in New York state, and included 602 participants with HCV enrolled between March 1, 2017, and Feb. 29, 2020. Data from Dec. 1, 2022, through Sept. 1, 2023, were included in the analysis. HCV treatment using direct-acting antivirals was prescribed either by facilitated telemedicine integrated into the existing OTPs (n = 290) or as standard-of-care off-site referral (n = 312).
The study found that 90.3% of participants in the facilitated telemedicine arm obtained an HCV cure compared with 39.4% in the referral arm. Substance use also decreased significantly in both arms, and there were minimal reinfections over two years of follow-up.
“I think that these findings begin to change how we think about the benefits of HCV treatment,” Dr. Talal said. “Not only does an HCV cure eliminate the risk for the development of end-stage liver disease, cirrhosis and potentially liver cancer, [but] it also serves as an important milestone on the road to recovery from opioid use disorder. This notion was reinforced by patient interviews among those who had been cured of HCV in which participants indicated that an HCV cure enabled them to accomplish many things in their lives, such as obtaining employment, getting married, buying houses, paying taxes and taking an interest in whole-person health.”
Implementing such programs on a larger scale, Dr. Talal said, would likely involve only minimal difficulty.
“The ability of a telemedicine provider to transcend time and space can promote the widespread adoption of the program,” he said. “We also found that the case manager who facilitated the entire telemedicine interaction was a key conduit for building trust with patients and promoting their retention in the program.”
The researchers hope future research will be able to address a few lingering questions raised by the trial.
“We found that Hispanic females overwhelmingly were cured in the telemedicine arm compared with referral,” Dr. Talal said. “Similarly, those in rural areas were much more likely to be cured through the facilitated telemedicine than referral. We believe that these two findings may be important to follow up through future investigation.”
Dr. Talal reported no relevant financial disclosures.
