Zooming to a cure: Harnessing telemedicine to offer mobile hepatitis C testing and treatment

Background: Despite the availability of highly effective directacting antiviral (DAA) therapies for hepatitis C virus (HCV), people who use illicit drugs or are experiencing homelessness face multiple barriers to accessing HCV treatment The aim of this project was to assess the feasibility and outcomes of offering low-threshold HCV treatment via telemedicine on a mobile HCV screening van Methods: In January 2019, we launched a mobile HCV screening van, offering free rapid HCV antibody testing followed by confirmatory HCV RNA testing and Fibroscan® for fibrosis staging at multiple sites in San Francisco (figure) In August 2019, we began offering linkage to an HCV clinician via telemedicine visits conducted with the patient utilizing a computer on the van Pre-treatment labs were drawn on the van, and DAAs were brought to the van for patients to pick-up Treatment initiation and other visits were all conducted via telemedicine on the van, and labs were drawn on the van during and after treatment Staff provided individualized appointment reminders, treatment plans, and strategies for safe medication storage Results: From 8/2019- 3/2020, 190 people were screened for HCV at 3 locations, and 32 (17%) tested positive for HCV RNA Sixteen patients elected to see a clinician via telemedicine on the van, and all initiated DAA therapy Median age of treated patients was 54 years, 56% were male, and 56 % were non-white All had a history of injection drug use, and most reported current injection or non-injection drug use Half were unstably housed, with 44% reporting staying at a shelter, outside, or in a vehicle Mental health comorbidities were common (56%), and 19% were HIV co-infected Three had compensated cirrhosis (19%), and 94% were treatment naive All had health insurance, but those needing a hepatology visit prior authorization waited longer from time of HCV RNA testing to starting treatment compared to those who did not: mean 76 ± 52 days vs 57 ± 31 days Thirteen patients completed treatment: SVR12 was confirmed in 7, SVR12 labs were delayed in 5 due to COVID-19, and 1 is awaiting SVR12 date One patient remains on treatment, and 2 received all of their medications but were lost to followup during COVID-19 Conclusion: Community-based HCV treatment via telemedicine on a mobile van is feasible and enables clinicians to treat patients where they are This model could be adapted in other community-based settings to colocalize HCV treatment with other services (Table Presented)