Telehealth Improves Hepatitis C Treatment in Patients With Opioid Use Disorder

Facilitated telemedicine integrated into an opioid treatment program led to better hepatitis C virus (HCV) cure rates compared with usual referral-based care, a randomized clinical trial showed.

In an intention-to-treat analysis, sustained virologic response (SVR) rates were substantially higher for those who had facilitated telemedicine compared with those referred for usual care (90.3% vs 39.4%), with a nearly threefold higher odds of achieving a cure (OR 2.9, 95% CI 2.0-3.5, P<0.001), Andrew Talal, MD, MPH, of the University at Buffalo, and colleagues reported in JAMA.

Notably, illicit drug use fell off significantly among cured participants in both the referral (P=0.001) and the facilitated telemedicine (P<0.001) groups, and few reinfections occurred, the researchers noted.

The study shows that HCV treatment can be successfully integrated into opioid use disorder (OUD) treatment programs using telemedicine, Talal told MedPage Today.

Despite its remote nature, facilitated telemedicine likely resulted in better outcomes due to the relationship between the patients, their case manager, and the provider, Talal pointed out.

“What we found was that people valued empathy, as measured by time spent with the doctor or the interpersonal manner of the provider, more than accessibility,” he said. “Having empathetic telehealth providers who paid attention to the patients, looked into the camera, and specifically practiced approaches to convey empathy — I think are some of the key aspects about this integration.”

While participants in both groups rated their healthcare delivery satisfaction as high or very high, Talal said qualitative interviews with OUD treatment program staff revealed that the facilitated telemedicine case managers were seen as collaborators, which improved patient interactions.

Talal said the findings “parallel very nicely” with a recent HHS rule change that makes permanent pandemic-era flexibilities around OUD treatment, as it could help facilitated telemedicine address a variety of conditions affecting people with OUD, beyond HCV treatment.

People with OUD are an underserved population, and injection drug users have a high incidence of HCV infection, the researchers noted. While telehealth promises improved access by transcending geographic and temporal boundaries, challenges such as limited access to digital technology and adequate broadband access remain.

One solution could be facilitated telemedicine, in which a healthcare staff member facilitates a connection between a patient and an off-site clinician.

To test that approach for increasing access to highly effective direct-acting antivirals (DAAs) for HCV among patients with OUD, Talal and colleagues conducted a prospective cluster randomized clinical trial using a stepped wedge design involving 12 OUD treatment programs in New York state.

All 12 facilities began with off-site referral. Every 9 months, four randomly selected sites transitioned to facilitated telemedicine without participant crossover.

A total of 602 patients with HCV were enrolled between March 2017 and September 2023. Overall, 290 were enrolled in the facilitated telemedicine program and 312 received standard-of-care off-site referrals. The majority of participants were male (61.3%), about half were white (50.8%), and the mean age was 47.1 in the telemedicine group and 48.9 in the standard care group.

More participants in the facilitated telemedicine group initiated treatment than those in the referral group (92.4% vs 40.4%), the researchers reported.

Similar to the intention-to-treat analysis, observed cure rates were higher in the facilitated telemedicine group compared with usual care (84.8% vs 34%).

The time between screening and initial appointments was significantly shorter in the facilitated telemedicine group (14 days vs 18 days, P=0.04) as was the time between the initial visit and DAA initiation (49.9 days vs 123.5 days, P<0.001).

There were no significant effects by subgroup, including fibrosis stage, living in an urban or rural setting, or mental health comorbidities such as anxiety or depression, the researchers reported.

The study was limited by a relatively low number of participating treatment facilities, and by the fact that it required enrollees to be actively participating in treatment of 6 months.

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