Telemedicine Improves HCV Elimination among Italian People Who Use Drugs: An Innovative Therapeutic Model to Increase the Adherence to Treatment into Addiction Care Centers Evaluated before and during the COVID-19 Pandemic

Abstract

People who use drugs (PWUDs) are generally considered “hard-to-treat” patients, due to adherence to HCV antiviral therapy or re-infection concerns. Linkage-to-care still remains a significant gap for HCV elimination, worsened by the COVID-19 pandemic. To reduce time-to-treat and improve treatment adherence, we have developed a patient-tailored model-of-care, decentralized within the addiction center and supervised remotely by hepatologists. From January 2017 to December 2020, patients were enrolled in one addiction care center in Southern Italy, where a complete hepatologic assessment, including blood chemistry, ultrasound, and transient elastography examination, was provided. DAAs treatment has been adapted on clinical features, also performing a daily administration during an outpatient visit, and monitored remotely by specialists via telemedicine interactions. Adherence was evaluated on the accomplishment of therapy or on the percentage of attended visits. From a total of 690 PWUDs, 135 had an active HCV infection and were enrolled in the study. All patients started the treatment within 3 weeks after HCV diagnosis. Six drop-outs were recorded, obtaining a sustained virological response at week 12 (SVR12) in 98.5% of PWUDs. There were only two cases of treatment failure, one of which is re-infection. No differences were found between the SVR12 rates before and during the COVID-19 pandemic. We obtained a high SVR12 rate, providing a comprehensive assessment within the addiction care center, tailoring the drug administration with a hepatologic remote stewardship. Our therapeutic model should improve the time-to-treat and treatment adherence in PWUDs.

Can Telemedicine Optimize the HCV Care Cascade in People Who Use Drugs? Features of an Innovative Decentralization Model and Comparison with Other Micro-Elimination Strategies

“…Previously, Radley et al [ 46 ] had also shown how care pathways carried out entirely at the local community pharmacy (where PWUDs receive substitution therapy) determined the optimization of the HCV care cascade through a more effective linkage to care and better adherence to therapeutic and management protocols than conventional care. Therefore, the choice of the different patient management place could explain the significant discrepancy in treatment adherence and follow-up compliance found between our model and the Punjab Model [ 8 , 35 ].…”

“…Our group has recently evaluated a decentralized assistance model, based on the use of telemedicine, with the aim of favoring linkage to care, reducing waiting times to start antiviral treatment, and optimizing the HCV treatment cascade in PWUDs patients ( Figure 2 ) [ 8 , 9 ].…”

“…In order to optimize the HCV care cascade in this population, several management and treatment models have been tested. Recently, Electronic Health (eHealth: remote monitoring, teleconsultation, mobile device–supported care, informative programs), including telemedicine, has been shown to positively impact HCV treatment processes among PWUDs, maximizing results, and could represent a successful weapon in the fight against viral hepatitis [ 8 , 9 ]. In particular, telemedicine helps to manage the diagnosis and antiviral treatment in a decentralized way, improving linkage to care and adherence to therapy, in addition to significantly reducing costs.…”

Chronic Hepatitis C: Pathophysiology and Clinical Issues

“…In this regard, Nevola and colleagues provided an in-depth review of the role and impact of telemedicine for the optimization of care in difficult-to-treat patients [ 14 ]. Furthermore, the same group showed the results of an innovative HCV treatment approach, employing a telemedicine-based hepatological stewardship for people who use drugs [ 15 ]. The authors enrolled 135 patients with active HCV infection; all patients started treatment within 3 weeks from HCV diagnosis.…”

“…The authors enrolled 135 patients with active HCV infection; all patients started treatment within 3 weeks from HCV diagnosis. Remarkably, only six drop-outs were recorded, while 98.5% of patients obtained an SVR at week 12 [ 15 ].…”