The results suggest that telemedicine could be used to help improve access for other populations that might be stigmatized, beyond hepatitis C virus and opioid use disorder.
Telemedicine is more effective for treating and curing hepatitis C virus (HCV) for individuals with opioid use disorder (OUD) compared to usual care, according to results of a treatment program by individuals from the University at Buffalo. The findings, presented at the American Association for the Study of Liver Diseases, also demonstrated that the advantages of being cured impacted sustainable health and social benefits.
According to a press release, there have been few randomized controlled trials to determine the effectiveness of telemedicine in those who are underserved, including those with OUD and HCV. The investigators aimed to determine the effectiveness in telemedicine for an opioid treatment program for HCV management, which would remove the need for offsite referrals, according to the investigators. The program was supported by an $8.2 million award from the Patient-Centered Outcomes Research Institute as well as more than $3 million from the Troup Fund of the Kaleida Health Foundation.
Investigators compared the onsite-facilitated telemedicine to offsite referrals with a specialist in HCV, which is the usual care for treating the virus. The telemedicine visits were facilitated by a case manager, who was an educator and patient advocate. The study was conducted at 12 opioid treatment programs in New York State from 2017 to 2022. The treatment programs also dispensed methadone, enrolling 602 individuals with OUD and HCV. The individuals received treatment with direct acting antiviral medications for HCV. Investigators followed the individuals for 2 years after being cured and evaluated them for reinfection, according to the press release.
The results showed that 90.7% of participants in the telemedicine arm were cured of HCV infection compared to 35.2% of individuals who were referred to an offsite specialist. Additionally, investigators found that approximately two-thirds of those in the referral arm did not initiate HCV treatment. In the follow up, investigators reported minimal HCV reinfections.
Furthermore, being cured of HCV also demonstrated subsequent health and well-being of individuals, including reductions in substance use. This was true for either arm, as long as the individual was cured. According to Andrew H. Talal, MD, professor of medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, interviews with the patients also showed that being cured of HCV improved self-confidence, helping the individuals address other health issues and challenges.
Furthermore, investigators reported that in many cases after treatment for OUD was initiated and HCV was cured, individuals were able to successfully seek employment, improve education, and reduce activity within the criminal justice system.
“Our study demonstrates how telemedicine successfully integrates medical and behavioral treatment,” Talal said in the press release. “Our participants viewed the opioid treatment program as a destigmatizing environment to begin with. When participants trust the staff in the program, that trust then extends to the telemedicine provider, especially when they express empathy. These attributes allow for successful HCV treatment and lead to high patient satisfaction through telemedicine.”
Talal added that telemedicine should be further investigated to increase health care access for other underserved populations with other health conditions. One of the key benefits of telemedicine was its ability to improve access for those with OUD who typically encounter stigma in other health care setting. Telemedicine could be used to help improve access to other type of care for other populations that might be stigmatized.
PCORI study: telemedicine treatment for HCV in people with opioid use disorder was more than twice as successful as offsite referral. News release. EurekAlert. November 10, 2023. Accessed November 14, 2023. https://www.eurekalert.org/news-releases/1007723