A simplified algorithm for managing hepatitis C infection by leveraging telemedicine

Abstract

Background:The utilization of alternative modalities to deliver patient care during the coronavirus disease of 2019 (COVID-19) pandemic has catalyzed the widespread adoption and integration of telemedicine into routine practice. These shifts have afforded a pivotal moment to analyze existing guidelines, such as for hepatitis C (HCV), identify opportunities, and streamline algorithms for optimizing disease management in remote settings.Methods and findings: Toward furthering momentum for targeting global HCV elimination, our cross-specialty expert panel collaborated to develop a simplified treatment algorithm for use in telemedicine environments by non-specialist providers (Figure 1). This algorithm includes a framework for delivery of HCV treatment and recommendations for screening, pre-treatment evaluation, on-treatment monitoring, and post-cure follow-up. The use of telemedicine for HCV management is supported by multiple studies demonstrating similar cure rates, measured by sustained virologic response at 12weeks post treatment (SVR12), compared to standard, in-person clinic visits. No laboratory monitoring is necessary for the majority of patients taking pan-genotypic direct-acting antivirals (DAAs), further reinforcing the ease of remote management of HCV treatment. Touchpoints to support medication adherence can be conducted through a variety of technologies, including bidirectional text messaging, electronic portals, and telephone and/or video conferencing. Conclusion:Telemedicine thus offers a critical opportunity to expand identification, link to care, and treat persons living with HCV.