Pain Medicine NewsHepatology Telehealth Integrated with Opioid Treatment Improves Hepatitis C Outcomes

Integrating telehealth with opioid treatment programs significantly enhances hepatitis C cure rates, reducing barriers such as stigma and logistical challenges.

A recent study demonstrated that integrating telemedicine appointments with hepatologists into opioid treatment programs (OTPs) significantly improves hepatitis C virus (HCV) cure rates. This approach addresses common barriers faced by people with opioid use disorder, such as stigma and logistical challenges, by facilitating easy access to direct-acting antivirals (DAAs) and continuous follow-up care.

Key Points:

• The study included more than 600 HCV-seropositive patients at 12 different OTPs across New York state, with a majority being male (61.3%) and nearly half (49.2%) identifying as non-white.
• Patients in the intervention arm had a case manager at the OTP facilitate a telemedicine appointment with a hepatitis specialist, who evaluated the participant, reviewed their bloodwork, and ordered DAAs.
• DAAs were delivered to the OTP and dispensed alongside methadone, with take-home doses provided for days when patients did not visit the OTP in person.
• The intervention arm saw a 92.4% treatment initiation rate and a 90.3% intention-to-treat cure percentage, compared to 40.4% and 39.4%, respectively, in the referral arm.
• The study highlighted the effectiveness of telemedicine in ensuring treatment initiation and follow-through, especially by minimizing common barriers such as stigma, time constraints, and childcare issues.
• The telemedicine intervention showed particularly profound effects in specific subgroups, such as Hispanic women and rural participants.
  • Hispanic women: 26 of 28 in the telemedicine arm were cured compared to 2 of 26 in the referral group.
  • Rural participants: 97.8% in the telemedicine arm were cured compared to 28.9% in the referral group.
• The intervention also supported OTP goals by reducing drug relapse and HCV reinfection rates during two years of follow-up.
• Experts noted the study’s potential to justify and expand telemedicine use in OTPs to improve healthcare access and outcomes for patients in recovery.
• Scaling up the intervention would require incentivizing and remunerating addiction centers to integrate such programs effectively.

“Right now, we have far fewer treaters of HCV than people with HCV, but the people who have it will never come to my office. This study shows how we can bring healthcare to the patients through the addiction centers.”
— Anurag Maheshwari, MD; Center for Liver and Hepatobiliary Diseases at Mercy Medical Center, Baltimore

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