Hepatitis C treatment for difficult to access populations; can telementoring (as distinct from telemedicine) help?

Hepatitis C treatment for difficult to access populations; can telementoring (as distinct from telemedicine) help?

Intern Med J. 2018 Aug 08;:

Authors: Mohsen W, Chan P, Whelan M, Glass A, Mouton M, Yeung E, Trinh Q, Arora S, Davison S, Lama T, Cobrador C, Levy MT

Abstract
INTRODUCTION: Hepatitis C (HCV) is curable, treatment of difficult to access populations (DTAPs) presents unique challenges. Project ECHO® (PE), a tele-mentoring program, adopted to support clinicians treating DTAPs.
AIMS: Determine if the PE model supports primary care clinicians treating HCV. Compare cohort of PE patients with those in a tertiary liver clinic (TLC).
METHODS: Weekly PE group video conferences were conducted. Clinical information, laboratory indices, psychosocial elements, and treatment outcomes including Sustained Virological Response (SVR) data were recorded in the first 100 consecutive cases and retrospectively compared to 100 consecutive patients seen at a tertiary liver clinic from July 2016 to April 2017.
RESULTS: Some patient characteristics were similar between PE and TLC: gender (72% male vs 75% male: p=0.23), median age (45 vs 50, p=0.344), proportion of treatment naïve patients (95.0% vs 90.9%). Treatment for HCV was commenced in 78% of the PE patients and 81% of the TLC patients. 67 of the TLC patients and 60 PE patients have confirmed SVR. PE patients are more likely to have ongoing substance use (44% vs 17% p<0.001), active IVDU (32% vs 17% p<0.001) and polysubstance abuse (26% vs 7% p<0.001) and were more likely to be taking opioid substitution therapy (OST) (74% vs 20% p<0.001). Indigenous patients were three times more greatly represented in PE (15% vs 5% p = 0.018).
CONCLUSION: Project ECHO® is an effective model to support primary healthcare providers treating HCV in DTAPs with similar rates of treatment uptake and SVR compared to patients in TLCs This article is protected by copyright. All rights reserved.

PMID: 30091164 [PubMed - as supplied by publisher]