Telemedicine Seen as Way to Treat HCV in Drug Users in Recovery

Talal’s research team will use the award from the Patient-Centered Outcomes Research Institute (PCORI) to study telemedicine as a method of treatment for drug users, a population that has traditionally been difficult to treat in conventional health-care settings.

Even when receiving regular treatment for substance abuse at methadone clinics, patients often don’t seek treatment for HCV, despite the fact that roughly half of them or more are likely chronically infected.

“The conventional method of treatment delivery — referral to an off-site location — has discouraged many individuals from initiating or completing treatment,” Talal says.

Talal notes these individuals are likely to possess low literacy skills and be affected by poverty and a lack of social support, making it difficult for them to navigate the health-care system.

They may have multiple medical conditions, including depression and anxiety, which often discourage them from seeking treatment for HCV, he says.

Misconceptions and distrust of the medical community also are factors, Talal says.

“These patients may perceive medical providers as judgmental, unresponsive to their medical needs and disdainful,” he says.

To combat these issues, integrating substance abuse treatment and HCV treatment has been widely advocated, but physical integration has been difficult to achieve since such services often aren’t available in the same clinic.

In the new project, Talal and his colleagues will use two-way live videoconferencing with patients in separate geographic locations as a treatment delivery strategy.

“Telemedicine permits virtual integration,” he notes. “This strategy enables HCV treatment to be delivered in the familiar environment of the opiate treatment program, allowing the HCV provider and the addiction medicine team to work together to evaluate and treat patients.”

Preliminary results have been promising.

At the recent International Liver Conference in Barcelona, Talal reported on a group of 18 drug users with HCV who were receiving addiction treatment at a methadone clinic in New York City. 

The patients received HCV medication while participating in biweekly telemedicine conferences with Talal, 400 miles away at UB.

“Not only did the patients grow increasingly comfortable with the telemedicine sessions, but they reported that they preferred these sessions over going to another site for treatment,” Talal says.

“Our conclusion from this small study was that telemedicine-based HCV care is a feasible, reimbursable model for drug users who are receiving treatment for their addiction in a methadone clinic.”

The PCORI-funded project aims to test that finding in a much larger population of 624 drug users at a dozen methadone clinics in and near Buffalo, Rochester, Albany and New York City.

“We have partnered with clinics from urban and rural locations, which ensures a diverse patient population,” Talal says.

The clinics will offer telemedicine to half of the patients and standard delivery of care (typically off-site referrals) to the other half.

While the primary outcome is viral eradication after treatment, measurement of patient satisfaction and treatment adherence are also important outcomes. Following up with patients who’ve completed treatment will enable researchers to evaluate the risk of reinfection.

“With this award, we will establish a statewide network of clinics that will follow patients who receive routine care through off-site referrals and subsequently compare it to treatment through telemedicine,” Talal says.

The spread of hepatitis C virus among drug users who share needles or other drug paraphernalia is seen as a casualty of the opioid epidemic.

Congressman Brian Higgins, a member of the Congressional Bipartisan Task Force to Combat the Heroin Epidemic, says this national crisis “creates secondary health, economic and social repercussions that pose their own challenges and require serious attention.”

“Research happening right here at the University at Buffalo is once again developing innovative treatment options, and this significant award demonstrates the confidence in UB’s work to help to address a national and growing problem,” he notes.

Other UB investigators on the project are:

• Marianthi Markatou, PhD, professor and associate chair for research in the Department of Biostatistics in the School of Public Health and Health Professions
• Richard D. Blondell, MD, professor and vice chair of addiction medicine in the Department of Family Medicine
• Anthony D. Martinez, MD, clinical associate professor of medicine

Other investigators are:

• Lawrence Brown, MD, chief executive officer of START Treatment & Recovery Centers
• Jonathan Tobin, PhD, president of Clinical Directors Network
• Don Des Jarlais, PhD, director of research, Baron Edmond de Rothschild Chemical Dependency Institute at Mount Sinai Beth Israel Medical Center

Talal conducts research on HCV and other liver diseases in UB's Clinical and Translational Science Institute and sees patients as a physician with UBMD Internal Medicine.

PCORI is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health-care decisions.