A Telementoring Program and Hepatitis C Virus Care in Rural Patients

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Background: Rural patients with chronic hepatitis C virus (HCV) infection may be less likely to access HCV care than those in urban areas. A telementoring, task-shifting model has been implemented to address the unmet needs of HCV care. Evidence is needed on whether this intervention improves HCV care in rural HCV patients.

Methods: We compared three key HCV care indicators among Medicare patients with chronic hepatitis C in 2014–2016 by urban–rural status between New Mexico with a telementoring program and Pennsylvania without such a program. We classified each patient’s urban–rural status based on his or her ZIP code of residence. We used multivariable log-binomial regressions to examine the relative probability of receiving HCV care by urban and rural status in two states.

Results: In New Mexico, 41.3% of HCV patients resided in rural areas (N = 1155). In Pennsylvania, rural patients accounted for 13.2% (N = 1775). The unadjusted overall rates of receiving HCV RNA or genotype testing within 12 months before HCV treatment were 76.1% in ‘‘rural-New Mexico’’ versus 73.3% in ‘‘rural-Pennsylvania,’’ 66.2% in ‘‘urban-New Mexico,’’ and 70.2% in ‘‘urban-Pennsylvania.’’ Post-treatment HCV RNA testing rate was also high in ‘‘rural-New Mexico’’ (83.0%). After adjusting for demographic and clinical characteristics, ‘‘rural-New Mexico’’ HCV patients who received HCV treatment still had the highest probability of taking HCV RNA or genotype testing before HCV treatment, compared with other groups (relative risk [95% confidence interval]: 0.91 [0.84–1.00] in ‘‘rural-Pennsylvania,’’ 0.85 [0.78–0.93] in ‘‘urban-New Mexico,’’ and 0.93 [0.87–1.00] in ‘‘urban-Pennsylvania’’).

Conclusions: The telementoring program may help improve HCV care in rural patients.