Curbing the hepatitis C epidemic requires routine screening of those ages 18-79, routine screening of pregnant women and regular screening of those with ongoing risk factors. A recent study looked at using mobile telemedicine as a way to identify and treat people with HCV who inject drugs.
This study in JAMA Network Open took place in rural areas (Vermont and New Hampshire) in a mobile van that was staffed with a medical assistant who drew blood and two researchers who provided harm reduction. Patients were required to be 18 years or older, have a current or past history of injection drug use, and have health insurance that would cover direct-acting antiviral therapy. Those with decompensated cirrhosis, pregnancy or prior DAA use were excluded.
Patients were seen for screening and enrollment and then had five more visits – one for randomization to telehealth versus referral for HCV care, and four subsequent follow-up visits. Those in the intervention arm had their telehealth visits with van staff present to provide support. Seventy-five people were randomized to each arm. Of note, 70% of the participants had been unhoused in the previous six months, with nearly as many having overdosed in the past and having used opioids within 30 days.
The mobile telehealth arm had 57 of 75 patients (75.8%) with follow-up data; the usual care arm had 62 of 75 (82.7%). In the intention-to-treat analysis, 43 started DAA therapy, and 28 had viral clearance in the mobile telehealth arm. In the usual care arm, 20 started DAA therapy, and 14 achieved viral clearance. Removing those who were lost to follow-up, the telehealth arm saw a viral clearance rate of 62.8% (27 of 43) while the usual care arm saw a rate of 65% (13 of 20).
In short, the difference in viral clearance between the two groups had everything to do with early initiation and reducing the chance of patients being lost in the referral vortex. Interestingly, there was no difference in ongoing equipment sharing between the two groups, perhaps because both groups got the same harm reduction education and support.
There have been several studies looking at whether mobile health vans can improve rates of diagnosis and treatment of various infectious diseases. Not all of them have found statistically positive results. One thing that may have helped uncover a significant difference in this study is that the van travelled to the same sites once or twice a week, making it easy for patients to follow up. Every study has unique factors (e.g., urban versus rural geography, presence of surrounding violence, weather conditions) that make generalization difficult, if not impossible. To me, this means that it’s essential to develop a program that understands the syndemics of the local infection landscape and is flexible enough to adjust and adapt as the program matures.
(Friedmann et al. JAMA Netw Open. Published online: Jan. 26, 2026.)
