BackgroundHIV pre-exposure prophylaxis (PrEP) awareness and uptake among at-risk individuals remains suboptimal despite clear evidence of efficacy. Health navigators and peer educators have been employed to facilitate linkage and retention in many aspects of HIV prevention and care, including to improve PrEP utilization. Yet, the use of health navigators to improve PrEP utilization has not been well-explored in rural areas where unique challenges to HIV care have been well documented. Little is known, too, about how telemedicine may strengthen these efforts. We assessed acceptability and evaluated a health navigation program that primarily engages clients through at-distance technology-based methods.MethodsTo guide the design and implementation of a pilot PrEP tele-navigation program, we conducted a survey in at-risk clients contacted through social networks and at a state-funded STI clinic in New Hampshire. Approximately nine months after the launch of the navigation platform, we analyzed characteristics of client-navigator interactions. Feedback surveys were distributed to clients 3 months following engagement with the navigator.ResultsFrom July 2017 to April 2018, 139 individuals engaged the navigator program via email, text, chat, phone call, or in-person. Among the most common services provided were PrEP counseling (n = 63 or 45% of inquiries), referral to STI/HIV testing (22%), and risk reduction counseling (19%). Eight clients have been linked to PrEP care to-date. Qualitative analysis of client-navigator interactions revealed a variety of recurring barriers expressed by clients including concerns maintaining confidentiality with parents and partners, side effects of PrEP, and financial constraints. Clients provided suggestions for program improvement and indicated they felt engagement with the program increased knowledge of PrEP as well as linkage to testing and HIV prevention services.ConclusionOur pilot program highlighted the diverse obstacles to PrEP utilization in at-risk rural clients, and suggests at-distance PrEP navigation and telemedicine can support improved PrEP utilization in the rural United States. Such a navigator program should be equipped to engage clients along the PrEP care continuum.Disclosures All authors: No reported disclosures.

BackgroundHepatitis C (HCV) is a curable cause of liver disease, typically treated by specialists. Access to specialists is limited in rural areas. Telemedicine between generalists and specialists could yield outcomes comparable with care provided by specialists in face-to-face (FTF) encounters. To assess the effectiveness of HCV treatment through telemedicine compared with usual care, as measured by sustained virologic response (SVR).MethodsWe searched MEDLINE, the Cochrane Library, ClinicalTrials.gov, the Database of Abstracts of Reviews of Effects, and Excerpta Medica DataBASE from inception to March 2018. We included Randomized Controlled Trials (RCTs) and cohort studies comparing telemedicine in rural settings to FTF encounters with specialists in treating HCV. Studies reported cure as measured by SVR. We did not apply any exclusion criteria. At least 2 independent researchers used PRISMA guidelines to extract data. We used a modified Newcastle-Ottawa Scale and the Cochrane Collaboration Tool for Assessing Risk of Bias to assess observational studies and RCTs. We used a random-effects model to calculate pooled odds ratios (OR). The primary outcome was clinical cure. Cure was defined as SVR at 12 weeks after completion of treatment.ResultsOf 1,211 potentially eligible studies, 10 studies, representing 43,117 subjects, met inclusion criteria. Pooled analysis showed no difference in the odds of achieving SVR when comparing telemedicine to FTF specialist care (OR 1.01 [95% CI 0.78–1.30]). This result was robust across sensitivity analyses, including restriction to patients who completed treatment (OR 0.78 [95% CI 0.43–1.43]), exclusion of outliers, and exclusion of abstracts. There was significant heterogeneity [P = 0.003, I2 = 64].ConclusionIn rural areas with limited access to specialists, care provided by telemedicine-supported generalists is as effective as FTF specialist care in achieving cure of HCV. Telemedicine is a viable option to expand access to HCV care in rural settings.Disclosures All authors: No reported disclosures.