Mobile Telemedicine Shows Promise in Expanding Hepatitis C Treatment Access

Access to hepatitis C (HCV) treatment can be especially challenging for people living in rural communities, particularly for individuals who inject drugs. Barriers such as limited health care providers, transportation challenges, stigma and lack of access to harm reduction services often make it harder for patients to get tested, treated and cured.

A new clinical trial published in JAMA explored whether bringing telemedicine-based HCV treatment directly to patients through a mobile van could help improve treatment access and outcomes.

“Treatment of HCV among people who inject drugs is a key strategy to achieving HCV elimination, yet access to HCV treatment is also limited in rural regions,” noted lead investigator Peter D. Friedmann, M.D., MPH, of the Department of Population and Quantitative Health Sciences at the University of Massachusetts Chan Medical School. “Numerous studies have demonstrated that timely, on-site, low-barrier care is superior to referral as a mechanism to ensure people who inject drugs obtain needed HCV care in the context of harm reduction and opioid treatment programs, mostly in urban settings.”

The addition of telemedicine to existing substance use treatment and harm-reduction services may help expand treatment to this patient population.

Investigators studied 150 adults living in rural counties in New Hampshire and Vermont who had chronic HCV and a history of injection drug use. Many participants faced significant social and health care barriers: About 70% experienced homelessness, and nearly two-thirds reported recent drug injection.

Participants were randomly assigned to one of two groups. The first group received mobile telemedicine care, where patients could meet with health care providers virtually through a mobile van that also offered syringe services and direct access to antiviral HCV medications. The second group received enhanced usual care, which included referrals to local or regional health care providers and support navigating the health care system, but treatment was not delivered directly through the mobile van.

The results showed that the mobile telemedicine approach significantly improved treatment access and success rates. More than half of participants receiving mobile telemedicine (57%) started HCV treatment, compared with only 27% of those receiving referral-based care. This means patients using the mobile telemedicine service were more than twice as likely to begin treatment.

The study also found that viral clearance, meaning the virus was no longer detectable in the blood 12 weeks after completing treatment, occurred more frequently in the telemedicine group. About 37% of participants using mobile telemedicine achieved viral clearance, compared with 19% in the enhanced usual care group. Viral clearance is considered a cure for HCV, which can help prevent serious long-term complications such as liver damage, cirrhosis and liver cancer.

However, the intervention did not reduce the sharing of injection equipment among participants. Investigators noted that while mobile treatment improves access to medication and cure rates, additional targeted harm reduction or behavioral support programs may still be needed to address injection safety practices.

Overall, the study suggests that mobile telemedicine programs that combine virtual health care visits with harm reduction services can play an important role in expanding access to HCV treatment for underserved populations. By meeting patients where they are, both geographically and socially, this approach may help improve treatment uptake and support national efforts to eliminate HCV as a public health threat.

“These findings suggest that referral to local HCV treatment clinicians, even with care navigation, is suboptimal to facilitate HCV treatment for rural people who inject drugs,” concluded investigators. “Optimal strategies should combine point-of-care HCV antibody and RNA testing; convenient, low-threshold telemedicine treatment integrated with enhanced harm-reduction or [medications for opioid use disorder] services; and peer support for HCV treatment.”