Using telehealth to improve access to hepatitis C treatment in the direct-acting antiviral therapy era

Abstract

Introduction One-third of the Australian population lives outside major cities and this group has worse health outcomes. Telehealth is becoming an accepted way to improve patient access to specialist healthcare. Over 200,000 Australian’s have hepatitis C virus (HCV) and new treatments are very effective and well tolerated. We aim to demonstrate that HCV treatment utilising telehealth support for care delivery has cure rates similar to onsite care in clinical trials. We also report length of consultation and calculate reductions in travel and carbon output. Methods Patient demographic, clinical, and treatment outcome data were collected prospectively from hospital software and analysed retrospectively. This was an audit of all patients treated for HCV in one year from a single tertiary hospital that included telehealth in their care delivery. Results Sustained virological response was achieved in 51/52 (98%) patients with completed treatment courses, and 51/58 (88%) of those who had a planned telehealth consultation as part of their management. A median of 634 km of patient travel was saved per telehealth consultation. Discussion We found that a telehealth-supported outreach programme for patients in regional Australia with HCV produced similar outcomes to clinical trials. There was a considerable saving in time and cost for the patients and significant environmental benefit through the reduction in carbon footprint associated with travel to distant specialist health services. We conclude that telehealth facilitated outreach is a feasible and effective way to access HCV treatment and cure in regional Australia.

Telehealth as an Important Player in the Management of Hepatitis C Virus

“…We included data from 16 selected studies that have utilized telehealth as an innovative mode of communication for the management of hepatitis C virus patients. Out of sixteen studies, ten studies were retrospective cohort studies [13][14][15]19,20,22,23,26,28,29], three were prospective cohort studies [18,24,30], one was a mixed methods study (both qualitative and quantitative components) [21] and the remaining two were observationaldescriptive studies [25,27]. The final selected studies were divided into four main categories which included improving treatment rates via utilizing telehealth services, satisfaction with telehealth services, disease management and health promotion, and similarity between telehealth and traditional modalities.…”

“…Later, a single study was found from cross-referencing which was also included. As a result of the whole screening process, we included 16 studies for the purpose of this review as per our pre-defined eligibility criteria [13][14][15][18][19][20][21][22][23][24][25][26][27][28][29][30]. The entire process of study screening and selection is exemplified in the PRISMA flow diagram in Figure 1.…”

“…Utilizing telehealth services enabled earlier access to healthcare services that can inhibit disease complications at a rapid rate. Studies showed that the feasibility, efficacy, and safety of telemedicine have resulted in an increased uptake of HCV treatments among patients, which contributed towards reducing the disease burden, particularly in remote and underprivileged areas that suffer additional challenges such as poverty and fewer medical experts, centers, and other basic resources [15,21,23,28]. A study done by Keogh et al in 2016 also showed a positive impact, as there was a more than four-fold increment in consultations, which reflects that telehealth increased patient engagement, decreased loss to follow-up, and reduced delay in seeking treatment among HCV patients [19].…”

“…This helped in building professional expertise via modern technology rather than the traditional healthcare model, thus empowering healthcare professionals and strengthening the healthcare system [23]. Further, it was estimated that 86,720 km of patient travel were saved via using the telemedicine service [28]. Therefore, the expansion of a team-based telemedicine model can play a pivotal role in the successful utilization of a service and curb the transmission of hepatitis C virus [19].…”

Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies

“…Implementing point-of-care testing using HCV core antigen would reduce loss-to-follow-up and increase the engagement of PWIDs into HCV care [ 59 , 60 , 61 , 62 ]. Efficient testing can also be employed using novel methods/technologies, such as the mobile health vans program (A-CHESS), which allows for the implementation of several services and the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders [ 63 ], and telehealth, which is cost-effective, saves time, and facilitates outreach/access to HCV treatment [ 64 ].…”