Theme: Clinical Research Year: 2018
Background:
Hepatitis C (HCV) is a curable cause of liver disease, typically treated by specialists. Access
to specialists is limited in rural areas, which in the US are seeing an increase in injection
drug use. Telemedicine between generalists and specialists could yield outcomes
comparable to care provided by specialists in face-to-face (FTF) encounters.
Methods:
We 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 sustained
virologic response (SVR). We did not apply any exclusion criteria. At least two 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, defined as SVR at 12 weeks after
completion of treatment.
Results:
Of 1,211 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 0.781.30]). This result was robust
across sensitivity analyses, including restriction to patients who completed treatment (OR
0.78 [95% CI 0.431.43]).
Conclusion:
In 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.
Disclosure of Interest Statement:
None of the authors has received funding from commercial entities or has financial interests
in commercial entities relevant to this study.