Telehealth for hepatitis C care in the DAA ERA; Ensuring everyone can access a cure

Background. The Victorian Infectious Diseases Service currently provides telehealth care for rural and regional patients with hepatitis C. From March 2016 direct acting antiviral therapy (DAA) for Hepatitis C has been subsidised for all Australian adults with Hepatitis C. The wide geographic distribution of Australia's population means patients have to travel considerable distances to access specialist care. The increasing availability of web-based videoconferencing platforms have provided unprecedented capacity to manage patients remotely. The primary aim of this study is to determine whether telehealth delivered hepatitis C management achieves virological outcomes comparable to that achieved in randomised clinical trials. Methods. The study is part of a quality audit of the hepatitis and outreach service. Measured outcomes were; (i) proportion of patients achieving a sustained viro-logical response (SVR); (ii) failure to attend rate (FTA); (iii) frequency of technical difculties; (iv) patient travel kilometres saved through not attending clinic in person; (v) Reduced carbon production due to reduced travel; and (vi) Consultation duration time. Results. In 1 year from March 1, 2016, 58 patients have been commenced on Hepatitis C treatment and managed either partially or completely via telehealth. Of those who have so far completed therapy (29 patients) an SVR rate of 97% has been achieved. Expected SVR genotype 1 (>95%); genotype 3 (>85%). The average travel avoided for each telehealth consultation was 616km and each patient had a median of two telehealth consultations. Technical difficulties occurred in less than 10% of consultations with FTA of 17%. Consult duration averaged 15 minutes or less. Conclusion. Our completed patient cohort results demonstrate comparable viro-logical outcomes for telehealth managed patients as compared with onsite management, even when adjusted for age, gender and hepatic fbrosis status. This suggests efforts to improve access to care can be achieved without compromising patient outcomes. Following the 2017 Infectious Diseases Society of America (IDSA) position statement on Telehealth and Telemedicine, we discuss the challenges and benefits of outpatient ID telehealth services as we enter the era of digitally enabled healthcare.