Integrated Hepatitis C-Opioid Use Disorder Care Through Facilitated Referral

Andrew H. Talal
Marianthi Markatou
Anran Liu
Poni Perumalswami
Amreen Dinani
Jonathan Tobin
Lawrence S. Brown
Peer-Reviewed Article
April 2024
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Facilitated telemedicine for hepatitis C virus (HCV) among opioid use disorder (OUD) patients in opioid treatment programs resulted in substantially higher cure rates than standard-of-care off-site referrals.


People with OUD often experience stigma and discrimination in medical settings, which dissuades them from accessing HCV treatment. HCV incidence among people who use drugs is high and access to direct-acting antivirals (DAAs), an evidence-based HCV treatment, remains limited among this population. This study explored if telemedicine integration into outpatient treatment programs (OTPs) resulted in greater access to DAAs and higher cure rates for HCV compared to in-person, off-site referrals.


The study recruited 602 OTP participants, 312 in off-site referrals and 290 in telemedicine. Among telemedicine participants, 92% of participants initiated DAA treatment and 90% achieved completion. However, only 40% of referred participants started treatment, with 37% completing it. Disparities in sustained virologic response (SVR) for HCV between the two groups told a similar story — 87% of telemedicine participants achieved SVR status, compared to only 35% of referred participants.

The study also found that facilitated telemedicine eliminated barriers, which prevent underserved populations from accessing OUD and HCV treatment. For instance, a high percentage of female Hispanic participants in the telemedicine groups achieved an SVR. Hispanic individuals typically have lower DAA treatment initiation rates due to medical mistrust, homelessness, fear of deportation, and other factors. Low-threshold access to DAA through telemedical clinicians may have alleviated some of these factors.


Stigma in medical settings prevents many OUD patients from initiating or continuing OUD treatment. This study suggests that telemedicine provides a non-stigmatizing, supportive approach to care for OUD patients. Telemedicine participants in the study reported high satisfaction scores for their providers, often rating clinician empathetic characteristics higher than other logistical factors, such as convenience.

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