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

Despite overall decline in hepatitis C virus (HCV) incidence in the United States, incidence in rural areas has continued to increase, primarily driven by injection drug use. Models of HCV care serving people in rural areas are needed. The TRAnsporting Hep C Viral ELimination Services via Telemedicine (TRAVEL) Program was implemented to increase access to HCV care in rural Maryland through an integrated model of local nurse case management support and facilitated telemedicine embedded within a local health department. Between January 2018 and March 2024, 502 anti-HCV+ patients were referred to the program. Of those referred, 384 [76%] were linked to care, with the majority having a substance use disorder (SUD) diagnosis [236 (61%)]. Laboratory draws and challenges with subsequent phone contact were barriers to initial linkage of referred individuals. Among the 282 patients who completed baseline labs and had HCV viremia, 272 [96%] attended a provider visit, 262 [93%] initiated DAA therapy, 254 [90%] completed treatment, 188 [67%] completed HCV cure labs and 186 [66%] had confirmed HCV cure. There was no significant difference in treatment initiation and completion between patients with and without SUDs, but patients with SUD were significantly less likely to complete HCV cure labs [aOR 0.43 (0.21, 0.82)]. The TRAVEL Program achieved high retention in care and HCV cure rates; however, a quarter of referred patients were not linked to care, and laboratory draws were a barrier along the care continuum. Strategies to optimize linkage and laboratory evaluation are needed.