Mobile Telemedicine Improves Hepatitis C Treatment Uptake in Rural Areas

Compared with referral-based care, mobile telemedicine delivery of hepatitis C virus (HCV) treatment significantly improves treatment uptake and viral clearance among people who inject drugs in rural areas, according to study findings published in JAMA Network Open.

Investigators conducted an open-label, randomized, parallel-group clinical trial (ClinicalTrials.gov Identifier: NCT05466331) to assess whether integrating telemedicine-delivered direct-acting antiviral (DAA) therapy with mobile syringe services could improve access to HCV care in underserved rural communities. Adults with chronic HCV infection and a history of injection drug use were recruited from 3 rural counties in New Hampshire and Vermont between April 2022 and January 2024, with follow-up completed in September 2024.

A total of 150 patients were included in the final analysis, with 75 randomly assigned to the mobile telemedicine care (MTC) intervention and 75 to enhanced usual care (EUC). Patients were a mean (SD) age of 38.1 (8.1) years, and 68.7% were men. Additional baseline characteristics reflected substantial social and clinical vulnerability: approximately 70.0% reported recent homelessness, 64.7% had injected drugs within the prior 30 days, 70.0% reported recent opioid use, and 68.0% reported a prior overdose history.

The MTC intervention provided telemedicine consultation, DAA prescribing, and treatment support directly through a mobile harm-reduction van offering syringe services. Patients assigned to EUC received referral to local or regional clinicians along with care navigation support. Both groups had access to harm-reduction supplies, vaccinations, and ongoing follow-up services.

Treatment initiation was substantially higher among patients who received mobile telemedicine care. DAA therapy was initiated by 57.3% of patients in the MTC group compared with 26.7% in the EUC group, representing more than twice the likelihood of treatment initiation (relative risk [RR], 2.15; 95% CI, 1.41-3.28). Missing treatment initiation data occurred in 25.3% and 17.3% of patients in the MTC and EUC groups, respectively.

Viral clearance outcomes showed a similar pattern. Clearance was documented in 37.3% of patients in the MTC group compared with 18.7% of those in the EUC group (RR, 2.00; 95% CI, 1.15-3.49). Missing viral clearance data were reported for 32.0% of patients in the MTC group and 21.3% of those in the EUC group. Among patients who initiated therapy, cure rates exceeded 60% in both groups, indicating that increased overall clearance largely reflected higher treatment uptake rather than differences in treatment effectiveness.

Changes in injection risk behavior were not observed. During follow-up, 46.7% of patients in the MTC and 49.3% of those in the EUC group reported ongoing sharing of injection equipment, with no statistically significant between-group differences (RR, 0.95; 95% CI, 0.68-1.32).

Follow-up data were available for 119 (79.3%) patients. Mortality during the study included 4 deaths in the telemedicine group (5.3%) and 3 deaths in the referral group (4.0%).

Study limitations include the open-label design, pandemic-related recruitment challenges, overlapping services between groups, and limited frequency of mobile van visits.

The investigators concluded, “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.” They added, “Optimal strategies should combine point-of-care HCV antibody and RNA testing; convenient, low-threshold telemedicine treatment integrated with enhanced harm-reduction or MOUD [medication for opioid use disorder] services; and peer support for HCV treatment.”

By Hibah Khaja, PharmD

References:

Friedmann PD, Wilson D, de Gijsel D, et al. Mobile telemedicine for treating chronic hepatitis C among rural people who inject drugs: a randomized clinical trial. JAMA Netw Open. Published online January 26, 2026. doi:10.1001/jamanetworkopen.2025.55125

Source: Infectious Disease Advisor