Table 3:

Telemedicine approaches for patients with HCV

Authors	Country	Study Design	Inclusion and Exclusion Criteria	Intervention and Comparison Groups	Outcomes
Videoconference
Doica et al., 2021 (15)	Romania	Pilot study (n = 41)	– Inclusion: received direct antiviral agent regimens from March 15 to May 15, 2020; prior diagnosis of HCV infection and followed by general practitioner. – % of patients with cirrhosis: N/A. – % of patients with genotype 3 HCV: N/A. – % of patients with HCV of other genotypes: N/A.	– Intervention: three visits with hepatologists via videoconferencing. Included initial assessments, education about indications and side effects of direct antiviral agents, and determination of patient adherence and compliance. – Comparison: in-person visits with hepatologists. – Videoconferencing software used: n/a, freely available video applications. – HCV treatment: dasabuvir with ombitasvir, paritaprevir, or ritonavir; ledipasvir with sofosbuvir.	– All patients in the intervention group were adherent to their medications vs. 94.7% in the comparison group (p = 0.0328). – All patients in the intervention group achieved sustained virological response (SVR). – Patients were satisfied with the care. Average score on the Telemedicine Satisfaction Questionnaire is 4.92 out of 5. – 89% of patients in the intervention group used their mobile phones. – 4.8% of visits were rescheduled due to poor Internet connection.
Nazareth et al., 2013 (16)	Australia	Prospective cohort study (n = 53)	– Inclusion: rural and remote adult with HCV; not pregnant; not trying to become pregnant; not breastfeeding; willing to use two forms of contraception. – % of patients with cirrhosis: 20% in intervention group (Hepascore greater or equal to 0.8). – % of patients with genotype 3 HCV: 36%. – % of patients with HCV of other genotypes: 64%.	– Intervention: visits with nurse practitioners via videoconferencing. Visits involved consultation, follow-up, HCV therapy initiation, and patient education. – Comparison: in-person visits. – Videoconferencing software used: N/A, bandwidth of 384 kbit/s ISDN or 1 Mbit/s IP. – HCV treatment: pegylated interferon and ribavirin.	– 50 patients were started on HCV therapy; 35 patients completed treatment. – Patients in the intervention group with genotype 1 infection had a higher SVR rate than the comparison group (73% vs. 51%, p-value >0.05). – Patients in the intervention group with genotype 2 and 3 had a similar SVR rate (70% vs. 68%). – 35 patients in the intervention group completed a questionnaire and were satisfied with the care.
Satellite site
Rossaro et al., 2013 (17)	United States	Retrospective cohort study (n = 80)	– Inclusion: 18–75 years of age, HCV infection diagnosed via PCR; had not received prior HCV treatment; referred to HCV specialist by general practitioner. – % of patients with cirrhosis: 27.5% (intervention group) and 45% (comparison group). – % of patients with genotype 3 HCV: 17.5% (intervention group) and 25% (comparison group). – % of patients with HCV of other genotypes: 82.5% (intervention group) and 75% (comparison group).	– Intervention: visits with hepatologists via videoconferencing at their PCP's clinics. The visits involved discussions about disease severity, treatment indications and contraindications, treatment benefits and side effects, risk of HCV transmission, monitoring, and follow-ups. PCPs performed physical examinations. – Videoconferencing software used: N/A. – Comparison: in-person visits. – HCV treatment: pegylated interferon and ribavirin.	– SVR rates were similar between groups (55% vs. 43%, p = 0.36). – The intervention group had a higher treatment completion rate (78% vs. 53%, p = 0.03). – The intervention group received 10 times more visits than the comparison group (19.6 vs. 0.07, p <0.0001). – Treatment discontinuation rate was higher in the intervention group because of depression (10% vs. 2.5%).
Halder et al., 2021 (18)	Australia	Prospective study (n = 332)	Inclusion: incarcerated; chronic HCV infection; referred from prisons within Western Australian East Metropolitan Health Service area; baseline investigations completed with recent Hepascore – % of patients with cirrhosis: 10% with Child Pugh A – % of patients with genotype 3 HCV: 52% – % of patients with HCV of other genotypes: 48%	– Intervention: video call with hepatologist, prison nurses, hepatology nurses, and telehealth coordinators. – Videoconferencing software used: Health Direct that allows for secure, encrypted video communications. – Comparison: none. – HCV treatment: sofosbuvir with velpatasvir, ledipasvir, daclatasvir, or velpatasvir and voxilaprevir; glecaprevir with pibrentasvir; elbasvir with grazoprevir.	– 332 patients were started on HCV therapy within 30 months. – 221 patients had SVR data; 91% of them achieved SVR. – 23 patients had cirrhosis and SVR data; 96% of them achieved SVR. – 29% of patients were lost to follow-up as they were released from prison. – The telemedicine clinic increased the number of prisoners seen per year from 10 to 137.
Phone call
Chen et al., 2014 (19)	Taiwan	Prospective study (n = 298)	– Inclusion: adult age; interferon treatment; minimum 2,000 copies of HCV RNA per millilitre of serum by PCR; elevated alanine aminotransferase above upper limit of normal 6 months prior; liver biopsy showing chronic HCV. – % of patients with cirrhosis: N/A. – % of patients with genotype 3 HCV: 14.2% (intervention group) and 13.3% (comparison group). – % of patients with HCV of other genotypes: 85.8% (intervention group) and 86.7% (comparison group).	– Intervention: 4 nurses and a physician provided telephone visits. Patients had the option to call health care professionals anytime. – Comparison: in-person visits with public health nurses at an outpatient clinic. – HCV treatment: pegylated interferon and ribavirin.	– SVR rates in the telemedicine and comparison groups were similar (68.9% vs. 66%). – 28.6% and 26% of patients in the telemedicine and comparison groups, respectively, experienced flulike symptoms. – Dropout rate was less in the intervention group (5.4% vs. 12%). – The telemedicine program cost less than the in-person program (112,500USD vs. 232,632USD).
Videoconference and phone call
Sivakumar et al., 2022 (20)	United States	Retrospective study (n = 31)	– Inclusion: opioid use disorder; actively injecting drugs; had insurance; referred for HCV testing. – % of patients with cirrhosis: 0%. – % of patients with genotype 3 HCV: N/A. – % of patients with HCV of other genotypes: N/A.	– Intervention: A clinician reviewed laboratory results with patients via telephone, ensured patients did not have contraindications to HCV treatment, and formulated a treatment plan. Patients had the option to receive counseling via telephone or videoconferencing. – HCV treatment: glecaprevir with pibrentasvir; sofosbuvir with velpatisvir.	– Of the 66 patients, 35 had chronic HCV infection; 31 patients were started on HCV treatment. – SVR rate was 93.5% among those who received treatment. – SVR rate was 83.3% among the 12 patients who were unstably housed.
Unspecified telemedicine intervention
Syed et al., 2021 (21)	United States	Prospective study (n = 870)	– Inclusion: patients in the Virginia Department of Corrections; positive HCV RNA; compensated liver disease – Exclusion: end-stage liver disease; hepatocellular carcinoma; comorbidities; less than 9 months sentence remaining; recent tattoos; recent alcohol or drug use. – % of patients with cirrhosis: 62% had cirrhosis, 18% had bridging fibrosis, median FIB 4 score = 2.15. – % of patients with genotype 3 HCV: N/A. – % of patients with HCV of other genotypes: N/A.	– Intervention: telemedicine visits that assessed compliance, tolerance, adverse effects, duration of treatment, and response to treatment. – HCV treatment: sofosbuvir with velpatasvir; glecaprevir with pibrentasvir; ledipasvir with sofosbuvir; elbasvir with grazoprevir; among patients with cirrhosis, ribavirin was used with ledipasvir and sofosbuvir or with sofosbuvir and velpatasvir.	– SVR rate was 97%. – Compliance was almost 100%.
Talal et al., 2019 (22)	United States	Prospective cohort study (n = 62)	– Inclusion: enrolled in an opioid substitution therapy for at least 3 months; had medical insurance. – % of patients with cirrhosis: 34.5%. – % of patients with genotype 3 HCV: N/A. – % of patients with HCV of other genotypes: N/A.	– Intervention: biweekly virtual sessions via videoconferencing with a hepatologist and an advanced practitioner as the telepresenter. – A regulatory compliant system was used. – HCV treatment: sofosbuvir with velpatasvir/ledipasvir/ribavirin; ombitasvir with paritaprevir, dasabuvir, and ribavirin; elbasvir with grazoprevir.	– 45 patients received HCV treatment; 93.3% were eradicated of HCV. – 17 patients were not treated. 3 discontinued from the program due to relocation or incarceration; 2 were lost to follow-up; 2 were nonadherent to treatment; 10 had issues with medical insurance. – Positive predictor of treatment included marriage and mental health diagnosis except for depression. Negative predictors of treatment included divorced, separated, and widowed.