By Devyani Gholap (Medscape.com)
TOPLINE:
Telemedicine-based treatment for hepatitis C virus (HCV) infection, delivered on a mobile van with syringe services, roughly doubled the rate of treatment initiation and significantly improved cure rates among rural people with chronic HCV infection and a history of injection drug use compared with enhanced usual care.
METHODOLOGY:
- Researchers conducted a randomized clinical trial in three rural US counties to compare treatment for HCV infection delivered via mobile telemedicine vs enhanced usual care for participants with a history of injection drug use and chronic HCV infection.
- A total of 150 participants (mean age, 38.1 years; 68.7% men) were randomly assigned (n = 75 each) to receive mobile telemedicine care or enhanced usual care.
- Mobile telemedicine care consisted of a direct-acting antiviral treatment administered via telemedicine on a mobile van with on-demand syringe services; enhanced usual care involved treatment referral by a mobile van staff with care navigation to local clinicians.
- The primary outcomes were the proportion of participants who initiated the direct-acting antiviral treatment, who achieved viral clearance at the 12-week follow-up, and who reported no sharing of syringes or other injection equipment at any follow‑up visit.
- Follow‑up visits were scheduled at the end of treatment and up to 36 weeks afterward and included a self-reported survey and HCV RNA testing.
TAKEAWAY:
- Overall, follow-up data were available for 79.3% of participants. The mobile telemedicine care group was more than twice as likely to initiate direct-acting antiviral treatment as the enhanced usual care group (relative risk [RR], 2.15; 95% CI, 1.41-3.28).
- Viral clearance at the 12-week follow-up was significantly higher in the mobile telemedicine group than in the enhanced usual care group (RR, 2.00; 95% CI, 1.15-3.49).
- No significant effect was observed on abstaining from sharing syringes or other injection equipment during follow-up.
IN PRACTICE:
“In aggregate, this emerging literature shows that telemedicine — whether facilitated through OTPs [opioid treatment programs], community-based peer interventions, or mobile vans — is a critical tool for lowering barriers to HCV treatment among people who use drugs,” experts wrote in an invited commentary accompanying the journal article.
SOURCE:
The study was led by Peter D. Friedmann, MD, MPH, University of Massachusetts Chan Medical School, Worcester, Massachusetts. It was published online on January 26, 2026, in JAMA Network Open.
LIMITATIONS:
The overlap in services, such as care navigation, harm‑reduction services, and vaccinations for hepatitis A and B viruses, likely reduced observed differences between the study groups. Because the study was not blinded, outcome assessments, particularly the self‑reported sharing of injection equipment, may have been biased. The van visited each site only once or twice weekly, which may have lowered follow‑up rates and affected the study outcomes.
DISCLOSURES:
The study was supported by the National Institute on Drug Abuse, CDC, and Substance Abuse and Mental Health Services Administration. Some authors reported receiving grants from these funders, one author reported receiving personal fees from Indivior for service on a scientific advisory board, and another reported serving as chief health officer of a private company subcontracted to deliver the telemedicine intervention and holding stock options.
