{"doi":"10.1001/jamanetworkopen.2025.55125","title":"Mobile Telemedicine for Treating Chronic Hepatitis C Among Rural People Who Inject Drugs","abstract":"<jats:sec>\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Persons who inject drugs in the rural US have high rates of chronic hepatitis C virus (HCV) infection and poor access to HCV testing, direct-acting antiviral (DAA) treatment, and syringe services. Effective approaches to test and treat this population are needed to achieve national HCV elimination goals.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To test whether a mobile telemedicine-based HCV treatment intervention increases HCV treatment initiation and viral clearance and decreases sharing of injection equipment among rural persons who inject drugs.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants</jats:title>\n                    <jats:p>This open-label, randomized, parallel-group clinical trial compared mobile telemedicine care (MTC) for HCV treatment with enhanced usual care (EUC), both integrated with van-based syringe services, from April 21, 2022, to September 13, 2024. Participants were persons aged 18 years or older with a history of drug injection and chronic HCV infection from 3 rural counties in New Hampshire and Vermont.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention</jats:title>\n                    <jats:p>MTC consisted of DAA treatment for HCV via telemedicine along with on-demand syringe services, all on a mobile van. EUC consisted of treatment referral by van staff, with care navigation to a local or regional clinician.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures</jats:title>\n                    <jats:p>Primary outcomes were the proportion of participants who (1) initiated DAA treatment for HCV, (2) achieved viral clearance at the 12-week follow-up, and (3) reported no injection equipment sharing at any point after the expected treatment completion visit.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Of 503 prescreened individuals, 169 were eligible and 150 were randomized to MTC (n = 75) or EUC (n = 75). Participants had a mean (SD) age of 38.1 (8.1) years, 103 (68.7%) were male, 105 (70.0%) experienced homelessness, and 97 (64.7%) reported drug injection in the past 30 days. MTC participants were more likely than EUC participants to initiate DAA treatment (43 [57.3%] vs 20 [26.7%]; relative risk [RR], 2.15 [95% CI, 1.41-3.28]) and to achieve viral clearance (28 [37.3%] vs 14 [18.7%]; RR, 2.00 [95% CI, 1.15-3.49]). No effect was detected on abstention from sharing of syringes or other injection equipment at follow-up (RR, 0.95; 95% CI, 0.68-1.32).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>In this randomized clinical trial, telemedicine for chronic HCV treatment integrated with syringe services on a mobile van was associated with improved access to HCV treatment initiation and cure for people with a history of drug injection in rural communities where HCV treatment services are scarce, suggesting optimal strategies in rural areas should include convenient, low-threshold telemedicine treatment.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration</jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05466331\">NCT05466331</jats:ext-link>\n                    </jats:p>\n                  </jats:sec>","journal":"JAMA Network Open","year":2026,"id":678710,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":778188,"name":"Donna Wilson","orcid":"0009-0001-6581-7615","position":1,"is_corresponding":false},{"id":1494684,"name":"David de Gijsel","orcid":"0000-0002-7987-7168","position":2,"is_corresponding":false},{"id":1066449,"name":"Kerry Nolte","orcid":null,"position":3,"is_corresponding":false},{"id":1446950,"name":"Jean Dejace","orcid":null,"position":4,"is_corresponding":false},{"id":1130126,"name":"Randall Hoskinson","orcid":"0000-0001-5414-7196","position":5,"is_corresponding":false},{"id":1773278,"name":"Lizbeth Del Toro-Mejias","orcid":null,"position":6,"is_corresponding":false},{"id":1066450,"name":"Elyse Bianchet","orcid":null,"position":7,"is_corresponding":false},{"id":1751057,"name":"Patrick Dowd","orcid":null,"position":8,"is_corresponding":false},{"id":629948,"name":"William E. Soares","orcid":"0000-0003-0760-7027","position":9,"is_corresponding":false},{"id":561907,"name":"Thomas J. Stopka","orcid":"0000-0003-2314-8924","position":10,"is_corresponding":false},{"id":191939,"name":"Peter D. Friedmann","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Mobile Telemedicine for Treating Chronic Hepatitis C Among Rural People Who Inject Drugs","abstract":"<jats:sec>\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Persons who inject drugs in the rural US have high rates of chronic hepatitis C virus (HCV) infection and poor access to HCV testing, direct-acting antiviral (DAA) treatment, and syringe services. Effective approaches to test and treat this population are needed to achieve national HCV elimination goals.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To test whether a mobile telemedicine-based HCV treatment intervention increases HCV treatment initiation and viral clearance and decreases sharing of injection equipment among rural persons who inject drugs.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants</jats:title>\n                    <jats:p>This open-label, randomized, parallel-group clinical trial compared mobile telemedicine care (MTC) for HCV treatment with enhanced usual care (EUC), both integrated with van-based syringe services, from April 21, 2022, to September 13, 2024. Participants were persons aged 18 years or older with a history of drug injection and chronic HCV infection from 3 rural counties in New Hampshire and Vermont.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention</jats:title>\n                    <jats:p>MTC consisted of DAA treatment for HCV via telemedicine along with on-demand syringe services, all on a mobile van. EUC consisted of treatment referral by van staff, with care navigation to a local or regional clinician.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures</jats:title>\n                    <jats:p>Primary outcomes were the proportion of participants who (1) initiated DAA treatment for HCV, (2) achieved viral clearance at the 12-week follow-up, and (3) reported no injection equipment sharing at any point after the expected treatment completion visit.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Of 503 prescreened individuals, 169 were eligible and 150 were randomized to MTC (n = 75) or EUC (n = 75). Participants had a mean (SD) age of 38.1 (8.1) years, 103 (68.7%) were male, 105 (70.0%) experienced homelessness, and 97 (64.7%) reported drug injection in the past 30 days. MTC participants were more likely than EUC participants to initiate DAA treatment (43 [57.3%] vs 20 [26.7%]; relative risk [RR], 2.15 [95% CI, 1.41-3.28]) and to achieve viral clearance (28 [37.3%] vs 14 [18.7%]; RR, 2.00 [95% CI, 1.15-3.49]). No effect was detected on abstention from sharing of syringes or other injection equipment at follow-up (RR, 0.95; 95% CI, 0.68-1.32).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>In this randomized clinical trial, telemedicine for chronic HCV treatment integrated with syringe services on a mobile van was associated with improved access to HCV treatment initiation and cure for people with a history of drug injection in rural communities where HCV treatment services are scarce, suggesting optimal strategies in rural areas should include convenient, low-threshold telemedicine treatment.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration</jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05466331\">NCT05466331</jats:ext-link>\n                    </jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41587029","pmcid":"PMC12836132","openalex_id":"https://openalex.org/W7125712488","authors":[],"funders":[],"total_grants":0,"fwci":22.421,"citation_percentile":0.99338422,"influential_citations":0,"citation_trend":[{"year":2026,"count":4}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2844220/friedmann_2026_oi_251467_1768515245.27403.pdf","host_type":"journal"},{"url":"https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2844220/friedmann_2026_oi_251467_1768515245.27403.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1001/jamanetworkopen.2025.55125","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/41587029","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12836132/","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12836132","host_type":"Europe_PMC"}],"fields_of_study":["Hepatitis C virus research","HIV, Drug Use, Sexual Risk","Telemedicine and Telehealth Implementation"],"mesh_terms":["Adult","Antiviral Agents","Female","Humans","Male","Middle Aged","New Hampshire","Rural Population","Substance Abuse, Intravenous","Telemedicine","Hepatitis C, Chronic"],"keywords":["Telemedicine","Chronic hepatitis","eHealth","Hepatitis C","Rural area","Chronic disease","Rural health"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"No poverty"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"nct"},{"name":"doi"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-17T05:54:57.339019Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}