{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:30:09Z","timestamp":1791876609093,"version":"4.3.4"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,4,23]]},"abstract":"\n Importance<\/jats:title>\n Facilitated telemedicine may promote hepatitis C virus elimination by mitigating geographic and temporal barriers.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare sustained virologic responses for hepatitis C virus among persons with opioid use disorder treated through facilitated telemedicine integrated into opioid treatment programs compared with off-site hepatitis specialist referral.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Prospective, cluster randomized clinical trial using a stepped wedge design. Twelve programs throughout New York State included hepatitis C\u2013infected participants (n\u2009=\u2009602) enrolled between March 1, 2017, and February 29, 2020. Data were analyzed from December 1, 2022, through September 1, 2023.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Hepatitis C treatment with direct-acting antivirals through comanagement with a hepatitis specialist either through facilitated telemedicine integrated into opioid treatment programs (n\u2009=\u2009290) or standard-of-care off-site referral (n\u2009=\u2009312).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was hepatitis C virus cure. Twelve programs began with off-site referral, and every 9 months, 4 randomly selected sites transitioned to facilitated telemedicine during 3 steps without participant crossover. Participants completed 2-year follow-up for reinfection assessment. Inclusion criteria required 6-month enrollment in opioid treatment and insurance coverage of hepatitis C medications. Generalized linear mixed-effects models were used to test for the intervention effect, adjusted for time, clustering, and effect modification in individual-based intention-to-treat analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 602 participants, 369 were male (61.3%); 296 (49.2%) were American Indian or Alaska Native, Asian, Black or African American, multiracial, or other (ie, no race category was selected, with race data collected according to the 5 standard National Institutes of Health categories); and 306 (50.8%) were White. The mean (SD) age of the enrolled participants in the telemedicine group was 47.1 (13.1) years; that of the referral group was 48.9 (12.8) years. In telemedicine, 268 of 290 participants (92.4%) initiated treatment compared with 126 of 312 participants (40.4%) in referral. Intention-to-treat cure percentages were 90.3% (262 of 290) in telemedicine and 39.4% (123 of 312) in referral, with an estimated logarithmic odds ratio of the study group effect of 2.9 (95% CI, 2.0-3.5;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) with no effect modification. Observed cure percentages were 246 of 290 participants (84.8%) in telemedicine vs 106 of 312 participants (34.0%) in referral. Subgroup effects were not significant, including fibrosis stage, urban or rural participant residence location, or mental health (anxiety or depression) comorbid conditions. Illicit drug use decreased significantly (referral: 95% CI, 1.2-4.8;\n P<\/jats:italic>\n \u2009=\u2009.001; telemedicine: 95% CI, 0.3-1.0;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) among cured participants. Minimal reinfections (n\u2009=\u200913) occurred, with hepatitis C virus reinfection incidence of 2.5 per 100 person-years. Participants in both groups rated health care delivery satisfaction as high or very high.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Opioid treatment program\u2013integrated facilitated telemedicine resulted in significantly higher hepatitis C virus cure rates compared with off-site referral, with high participant satisfaction. Illicit drug use declined significantly among cured participants with minimal reinfections.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02933970<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.2452","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T11:24:09Z","timestamp":1712143449000},"page":"1369","source":"Crossref","is-referenced-by-count":66,"title":["Integrated Hepatitis C\u2013Opioid Use Disorder Care Through Facilitated Telemedicine"],"prefix":"10.1001","volume":"331","author":[{"given":"Andrew H.","family":"Talal","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianthi","family":"Markatou","sequence":"additional","affiliation":[{"name":"Department of 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