BUFFALO, N.Y. — Telemedicine is widely recognized as an important tool for improving access to health care for medically underserved populations. However, there are few randomized controlled trials to determine its effectiveness in treating these populations.
People with opioid use disorder, a population underserved in traditional health care settings, are at the highest risk of contracting hepatitis C virus (HCV) through needle sharing.
University at Buffalo researchers explored the effectiveness of integrating telemedicine into an opioid treatment plan for hepatitis C management, eliminating the need for off-site referrals. This work was supported by an $8.2 million grant from the Patient-Centered Outcomes Research Institute (PCORI) and more than $3 million in Kaleida Health Foundation Troup funds.
The purpose was to compare on-site facilitated telemedicine with off-site referral to an HCV specialist, a common approach to care for treating HCV in these individuals. In this model, telehealth encounters are facilitated by a case manager who also serves as a patient advocate and educator.
What they found: Not only was telemedicine more effective than usual care in treating and curing this population, but the healing benefits also resulted in sustainable health and social benefits.
The UB researchers will present their findings Nov. 13 at the American Association for the Study of Liver Diseases annual meeting in Boston.
Nearly 91% of telemedicine participants were cured
The study was conducted at 12 opioid treatment programs distributing methadone in New York state from 2017-22. Researchers recruited 602 participants with opioid use disorder and diagnosed with HCV. Participants were treated with direct-acting antiviral drugs for HCV and followed for two years after cure to assess for reinfection.
The researchers found that 90.7 percent of the telemedicine group who received an opioid treatment program were cured of their HCV infection, compared with 35.2 percent of participants who were referred to an offsite specialist. Two-thirds of those in the referral group never started hepatitis C treatment.
During the two-year follow-up period, there were few HCV reinfections in either group studied.
“Telemedicine can improve patient care and retention in treatment in this population,” said lead researcher Andrew H. Talal, MD, professor of medicine at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.
The researchers also found that cure from the hepatitis C virus led to subsequent improvements in participants’ health and well-being, including significant reductions in substance use.
“We observed a significant reduction in medication use among all those who were cured, regardless of which study group they belonged to,” Talal added. “Interviews with patients revealed that being cured of HCV boosted their self-confidence and made them feel more confident. They are able to address other health issues and challenges in their lives.”
In many cases, after initiating treatment for opioid use disorder in conjunction with hepatitis C treatment, individuals are able to successfully find employment, improve their educational status, and reduce involvement with the criminal justice system.
Talal said a key advantage is the innovative approach to integrating hepatitis C treatment telemedicine into the setting where patients receive methadone treatment.
He explained that their findings demonstrate a key benefit of telemedicine: It improves access to health care for people with opioid use disorder, who often encounter avoidance and stigma in traditional health care settings. It also demonstrates how telemedicine can help improve access to different types of care.
“Our study shows how telemedicine can successfully combine medical and behavioral treatments,” he said. “Our participants first view the opioid treatment program as a destigmatizing environment. When participants trust the staff in the program, that trust extends to the telehealth providers, especially when they When expressing empathy. These attributes contribute to successful treatment of HCV and increased patient satisfaction through telemedicine.”
Talal said the results suggest telemedicine should be further studied as a way to increase access to health care for other underserved populations with other health conditions.
Additional highlights of the study include its success in enrolling underserved populations in clinical research and the successful implementation and completion of a complex clinical trial at a site that provides clinical care for patients with opioid use disorder.
In addition to his role at the Jacobs School, Talal is a physician at UBMD. He has conducted numerous clinical trials of new treatments for liver disease, including hepatitis C virus. He is also a member of the New York State HCV Elimination Program Recommendations Task Force and chair of the New York State HCV Telemedicine Task Force.
UB co-authors include Talal and Marianthi Markatou, Ph.D., Distinguished Professor in the Department of Biostatistics in the SUNY College of Public Health and Health Professions; Anran Liu, a doctoral student in the Department of Biostatistics; and Lawrence Brown, M.D., formerly of START Treatment and Rehabilitation Center; Ponni Perumalswami, MD, and Amreen Dinani, MD, both of the Ichan School of Medicine at Mount Sinai; and Dr. Jonathan Tobin, clinical director of the network and Rockefeller University.
This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) award (IHS-1507-31640) and in part by a Kaleida Health Foundation Troup grant. The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or the Methods Committee.