Utilizing Telemedicine to Engage Rural Patients With Substance Use Disorders in Low Barrier Hepatitis C Treatment

Area of Science:

• Hepatology
• Public Health
• Telemedicine

Background:

• Hepatitis C virus (HCV) incidence is rising in rural US areas, driven by injection drug use.
• Existing HCV care models are insufficient for rural populations.
• Novel approaches are needed to improve HCV treatment access in underserved regions.

Purpose of the Study:

• To evaluate the effectiveness of the TRAnsporting Hep C Viral ELimination Services via Telemedicine (TRAVEL) Program.
• To assess the program's ability to increase access to HCV care in rural Maryland.
• To identify barriers and facilitators in the HCV care continuum within a rural setting.

Main Methods:

• The TRAVEL Program integrated local nurse case management with telemedicine services.
• 502 anti-HCV+ patients were referred between January 2018 and March 2024.
• Data on linkage to care, treatment initiation, completion, and cure were analyzed, including subgroup analysis for patients with substance use disorders (SUDs).

Main Results:

• 76% of referred patients were linked to care, with 61% having a SUD diagnosis.
• Among patients with viremia, 96% attended a provider visit, 93% initiated DAA therapy, and 66% achieved confirmed HCV cure.
• Patients with SUDs were less likely to complete HCV cure labs (aOR 0.43).

Conclusions:

• The TRAVEL Program demonstrated high retention and HCV cure rates in a rural setting.
• Barriers to care linkage and laboratory completion persist, particularly for patients with SUDs.
• Optimizing patient linkage and laboratory processes is crucial for comprehensive HCV elimination in rural communities.