Telemedicine significantly increases the success of hepatitis C treatment in rural patients

New research conducted by OHSU finds that the use of telemedicine combined with outreach from colleagues with personal experience in illicit drug use significantly improves the diagnosis and cure of hepatitis C, the most common blood-borne virus in the United States . (Getty Images)

New research shows dramatic improvement in diagnosing and curing people with hepatitis C in rural communities using both telemedicine and support from peers with real-world drug use experience.

The study was published today in the journal Clinical infectious diseasesoutlines the results of a randomized controlled trial led by Oregon Health & Science University in seven rural counties in Oregon. The study called on people with practical substance use experience to meet drug users, test them for hepatitis C, and then offer them treatment through telemedicine or referral to a physical clinic.

The results were striking.

Researchers found that 85% of people were able to successfully book in for treatment using a tablet or smartphone, compared to just 12% of those referred for face-to-face care at a clinic. Additionally, the majority of people who were offered telehealth care – 66% – cleared the virus within six months of starting the study.

Each approach relied on engaging people through peers with experience in illicit drug use.

Andrew Seaman, MD (Courtesy)

“Rural people who use drugs may be more likely to trust their peers, even if they do not trust health care providers,” said the lead author Andrew Seaman, MDAssociate Professor of Medicine (General Internal Medicine and Geriatrics) at the OHSU School of Medicine. “This study demonstrates the importance of empowering trusted colleagues to support the health of drug users and the critical role telemedicine can play in expanding hepatitis C treatment to rural communities.”

Hepatitis C is the most common blood-borne virus in the United States, affecting an estimated 2.4 million people.

Stopping the spread of hepatitis C has become much more feasible in recent years with the availability of antiviral therapies that are more than 95% effective in eliminating the virus and with few side effects. Still, providing testing and treatment remains a major hurdle in containing the continued spread of the disease and its impact on public health.

“We have life-saving medications to treat hepatitis C,” Seaman said. “This study shows that finding unique ways to improve access to treatment – ​​beyond traditional health care – is critical to supporting people who use drugs.”

Improving treatment connections

In the study, 203 people in rural areas who use drugs were randomized between July 2020 and December 2022 and contacted by peers with personal experience of drug use.

All participants were referred to care either through a peer-assisted referral to local treatment resources in their community or through a peer-assisted telehealth connection to healthcare professionals via a tablet or smartphone.

The study found that those who received telehealth care were nearly seven times more likely to be treated for hepatitis C and four times more likely to achieve viral clearance after six months.

The research team believes this is the first randomized trial to validate telehealth in rural populations with hepatitis C and the first to evaluate peer-supported telehealth. Unlike other viral epidemics such as HIV, the prevalence of hepatitis C is higher in rural areas and occurs primarily among people who use drugs.

The use of telemedicine in general has increased significantly since the COVID-19 pandemic, but this study is the first to document its potential for nationwide expansion in combating hepatitis C, particularly as the Biden administration embarks on a five-year initiative to Elimination of the disease is concentrated in the United States.

“This is one of those rare situations where spending money actually saves money,” said Seaman, who also serves as medical director of hepatitis and HIV services for Central City Concern, a Portland-area nonprofit that provides housing, health care and addiction treatment offers services. “Hepatis C causes liver cancer, loss of productivity, diabetes and all kinds of complications that cost lives and money. And it is transmissible, so every time a patient is cured, we also prevent multiple transmission to other people.”

Seaman also directs substance use disorder programs at Better Life Partners, which provides low-barrier treatment within a harm reduction framework throughout New England.

Peers make an impression

In Oregon, to conduct this research, researchers leveraged an existing initiative called Oregon HIV/Hepatitis and Opioid Prevention and Engagement, or Oregon HOPE, a collaboration between OHSU, the Oregon Health Authority, Comagine Health and community-based organizations.

The initiative relies on peers recovering from addiction to engage their neighbors in substance abuse prevention and treatment services. Funded by the National Institute on Drug Abuse of the National Institutes of Health, the program works with community organizations in Lane, Douglas, Josephine, Curry, Coos, Jackson and Umatilla counties.

Todd Korthuis, MD, MPH (OHSU)

“This study teaches us that local colleagues in rural communities can provide direct care to people who often slip through the cracks of our health care system,” said co-author Todd Korthuis, MD, MPHChief of Addiction Medicine at OHSU, Professor of Medicine (General Internal Medicine and Geriatrics) at OHSU School of Medicine, and Principal Investigator of Oregon HOPE. “It’s a deeply enjoyable new way of doing business.”

This research was supported by grant UH3DA044831 from the National Institute on Drug Abuse of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.