Direct Acting Antivirals and Hepatitis C Clearance: The Role of Telemedicine Programs in Rural Primary Care

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Objective: Hepatitis C Virus (HCV) infection is commonly associated with Intravenous Drug Use (IVDU). Chronic infect ion leads to increased risk of progressive liver disease. The aim of this study was to identify the value of an opportunistic screening program for people at risk of HCV infection (IVDU) and to examine the effectiveness of Project ECHO relating to HCV clearance. Project ECHO (Extension for Community Healthcare Outcomes) is a telemedicine treatment program facilitating treatment of HCV in a rural community setting. Methods: A retrospective case audit was completed using data collected in the primary care environment in the Southern Highlands of New South Wales. Data was examined from patients over 18 years of age, who were part of an opportunistic screening program and were at risk of HCV. HCV patterns, patient demographics and enrollment in Project ECHO was examined in relation to HCV clearance. Results: Opportunistic screening identified that nearly 76% of HCV positive patients were undertaking opiate replacement therapy, almost all were smokers and over 50% reported a history of alcohol abuse, reinforcing the relationship between substance abuse and HCV. In addition, significant chronic medical comorbidities related to addiction and mental health were identified. HCV treatment via Project ECHO achieved viral clearance in 88% of the Project ECHO cohort (n= 34). Conclusion: Telemedicine programs such as Project ECHO provide an effective pathway for achieving HCV clearance in at risk patients. There are significant implications for primary and continuity of care in the monitoring and implementation of HCV prevention and treatment in rural Australia. Opportunities for targeted HCV screening and further regional investigation of high-risk groups present key areas for future research.