Telemedicine successfully engages marginalized rural hepatitis C patients in curative care

Abstract

Background: Rurally located individuals living with hepatitis C virus (HCV) face barriers to engagement and retention in care. Telemedicine technologies coupled with highly curative direct acting antiviral (DAA) treatments may increase accessibility to HCV care while achieving high sustained virologic response (SVR) rates. We compared clinical and socio-economic characteristics, SVR, and loss to follow-up among telemedicine (TM), mixed delivery (MD), and outpatient clinic (OPC) patients receiving care through The Ottawa Hospital Viral Hepatitis Program (TOHVHP). Methods: TOHVHP clinical database was used to evaluate patients engaging HCV care between January 1, 2012, and December 31, 2016. SVR rates by HCV care delivery method (TM versus OPC versus MD) were calculated. Results: Analysis included 1,454 patients who engaged with TOHVHP at least once. Patients were aged almost 50 years on average and were predominately male and Caucasian. A greater proportion of TM patients were rurally based, were Indigenous, had a history of substance use, and had previously been incarcerated. Per-protocol DAA SVR rates for TM, OPC, and MD patients were 100% (26/26), 93% (440/472), and 94% (44/47), respectively. Loss-to-follow-up rates for HCV-treated TM and MD patients were higher (27% [10/37], 95% CI 0.58 to 0.88, and 11% [7/62], 95% CI 0.81 to 0.97, respectively) than for those followed exclusively in the OPC (5% [39/800], 95% CI 0.94 to 0.97). Conclusions: TM can successfully engage, retain, and cure rurally based HCV patients facing barriers to care. Strategies to improve TM retention of patients initiating HCV antiviral treatment are key to optimizing the impact of this model of care.

Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation

“…TM could offer a novel approach in bringing health and health equity into all population groups and regions, in particular when referral to specialists is limited. Results of a Canadian study ( Lepage et al., 2020 ) indicate the use of real-time telemedicine as successful in the engagement of rurally based patients to HCV treatment among highly vulnerable and marginalized patient groups (IDU history >72%). Similar success (97% overall SVR rate) can be seen among incarcerated populations following DAA for HCV ( Jiménez Galán et al., 2019 ) .…”

Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake

“…All 29 studies were published between 2017 and 2021 with the majority (n = 27) published within the last two years. Twenty-one studies were based in the USA [ 31 – 51 ], three in Australia [ 52 – 54 ], two in Canada [ 55 , 56 ], and one each in Chile [ 57 ], Italy [ 58 ] and Scotland [ 59 ]. One based their research in primary and secondary care settings [ 37 ], one in primary and tertiary care [ 44 ], eleven solely in secondary care [ 39 , 41 , 45 , 46 , 51 , 52 , 55 – 59 ] and sixteen in tertiary care [ 31 – 36 , 38 , 40 , 42 , 43 , 47 – 50 , 53 , 54 ].…”

“…Twenty-one studies were based in the USA [ 31 – 51 ], three in Australia [ 52 – 54 ], two in Canada [ 55 , 56 ], and one each in Chile [ 57 ], Italy [ 58 ] and Scotland [ 59 ]. One based their research in primary and secondary care settings [ 37 ], one in primary and tertiary care [ 44 ], eleven solely in secondary care [ 39 , 41 , 45 , 46 , 51 , 52 , 55 – 59 ] and sixteen in tertiary care [ 31 – 36 , 38 , 40 , 42 , 43 , 47 – 50 , 53 , 54 ]. The research was specifically set in the context of COVID-19 in twenty-one studies [ 32 , 33 , 35 – 39 , 41 , 43 – 51 , 54 , 56 – 58 ].…”

“…Twenty-two studies considered a single clinical specialty; the remaining seven included patients with any condition or those with chronic conditions in general. A retrospective cohort study was the most frequent study design [ 31 , 36 – 41 , 44 , 45 , 47 , 49 , 55 ]. All but one study reported data on participants’ gender [ 49 ], with twenty reporting ethnicity data [ 31 – 33 , 35 – 42 , 44 – 46 , 48 – 51 , 53 , 55 ] and fifteen mean age [ 31 – 35 , 39 , 42 , 46 , 48 , 51 – 54 , 57 , 58 ] ( Table 2 ).…”

“…A retrospective cohort study was the most frequent study design [ 31 , 36 – 41 , 44 , 45 , 47 , 49 , 55 ]. All but one study reported data on participants’ gender [ 49 ], with twenty reporting ethnicity data [ 31 – 33 , 35 – 42 , 44 – 46 , 48 – 51 , 53 , 55 ] and fifteen mean age [ 31 – 35 , 39 , 42 , 46 , 48 , 51 – 54 , 57 , 58 ] ( Table 2 ). Twenty one studies reported data from a single time period [ 31 – 34 , 36 , 37 , 39 , 40 , 42 – 44 , 47 , 49 , 52 – 59 ], and eight reported a comparison of remote consultation uptake rates across two time periods [ 35 , 38 , 41 , 45 , 46 , 48 , 50 , 51 ].…”