Telemedicine results in higher HCV cure rates vs. referral in opioid treatment programs
Click Here to Manage Email Alerts
Key takeaways:
- Among patients with HCV and opioid use disorder, intention-to-treat cure rates were 90.3% with telemedicine vs. 39.4% with referral.
- Overall, reinfections were low, with an incidence of 2.5 per 100 person-years.
Facilitated telemedicine integrated into opioid treatment programs for patients with hepatitis C virus infection resulted in “substantially higher” cure rates compared with offsite referral to a hepatitis specialist, according to a study.
Additionally, illicit drug use declined among all cured patients.
“People with opioid use disorder are an underserved population largely because of societal stigma,” Andrew H. Talal, MD, MPH, professor of medicine and director of the Center for Research and Clinical Care in Liver Disease at the University of Buffalo, and colleagues wrote in JAMA. “Opioid treatment programs (OTPs) are convenient, comfortable and non-stigmatizing health care delivery sites that successfully integrate medical and behavioral treatment for opioid use disorder.
“In a single-group, single-site study, HCV care through OTP-integrated facilitated telemedicine encounters integrated into OTPs resulted in high cure rates with high patient satisfaction.”
In a prospective, cluster randomized clinical trial, Talal and colleagues compared sustained virologic response rates among 602 patients (61.3% men; 50.8% white) with HCV and opioid use disorder at 12 OTPs throughout New York between March 2017 and February 2020. Researchers enrolled 290 patients (mean age, 47.1 years) into a group that received facilitated telemedicine for HCV treatment and 312 patients (mean age, 48.9 years) into a group that received standard-of-care referral to a hepatitis specialist.
All programs began with offsite referral to a hepatitis specialist, and every 9 months four sites transitioned to facilitated telemedicine during three separate steps without patient crossover.
The primary outcome was HCV cure. Secondary outcomes included treatment initiation and completion rates with direct-acting antivirals, patient satisfaction with delivery of care and treatment adherence rates. The incidence of HCV reinfection was an exploratory outcome.
According to results, 96.6% of patients in the telemedicine group completed their initial visit, as did 95.2% in the referral group. Conversely, 92.4% and 40.4%, respectively, initiated treatment with DAAs.
Intention-to-treat cure rates were 90.3% vs. 39.4%, with an estimated logarithmic odds ratio of time-averaged intervention effect of 2.9 (95% CI, 2-3.5), based on combined results of 20 datasets.
In addition, patients in the telemedicine group experienced significantly shorter time between screening and initial appointments compared with those in the referral group (median, 14 vs. 18 days), as well as less time between initial appointments and treatment initiation (mean, 49.9 vs. 123.5 days).
Illicit drug use decreased significantly in both telemedicine (95% CI, 0.3-1) and referral (95% CI, 1.2-4.8) groups, and researchers reported minimal reinfections (n = 13), with an overall incidence of 2.5 per 100 person-years.
Individuals in both groups rated satisfaction with health care delivery as “high or very high.”
“OTP-integrated facilitated telemedicine resulted in substantially higher sustained virologic response rates than offsite referral,” Talal and colleagues wrote. “Our intervention successfully builds patient-clinician trust across the screen and significant decreases in substance use were observed in cured participants with minimal HCV reinfections.”
They continued: “Opioid treatment program-integrated facilitated telemedicine promotes increased access and integrates HCV treatment into venues that offer opioid use disorder treatment.”
Collapse
Read more about
Click Here to Manage Email Alerts