A randomized clinical trial published January 26, 2026, in JAMA Network Open demonstrates that mobile telemedicine significantly improves hepatitis C treatment uptake among people who inject drugs in rural areas. The study, conducted across rural counties in New Hampshire and Vermont between April 2022 and January 2024, found that delivering direct-acting antiviral (DAA) therapy via a mobile harm-reduction van increased treatment initiation by more than double compared to traditional referral-based care.
Researchers enrolled 150 participants with chronic hepatitis C virus (HCV) infection and a history of injection drug use, randomly assigning 75 to the mobile telemedicine care (MTC) intervention and 75 to enhanced usual care (EUC). The average age of participants was 38.1 years, and 68.7% were male. The study population too exhibited significant social and clinical vulnerabilities, with approximately 70% reporting recent homelessness, 64.7% having injected drugs within the prior 30 days, 70% reporting recent opioid use, and 68% with a prior overdose history.
The MTC intervention provided telemedicine consultations, DAA prescriptions, and treatment support directly through the mobile van, which also offered syringe services. Participants in the EUC group received referrals to local or regional clinicians, along with care navigation support. Both groups maintained access to harm-reduction supplies, vaccinations, and ongoing follow-up services.
Results indicated that 57.3% of patients in the MTC group initiated DAA therapy, compared to 26.7% in the EUC group. This represents a relative risk of 2.15 (95% CI, 1….) for treatment initiation among those receiving mobile telemedicine care. The findings align with previous research highlighting the effectiveness of low-barrier care and mobile services in expanding access to HCV treatment in rural settings, according to the Hep Coalition.
Peter D. Friedmann, MD, MPH, of the University of Massachusetts Chan Medical School, led the research. The study underscores the potential of decentralizing care and expanding telemedicine access to address structural barriers to HCV treatment, particularly among rural populations who inject drugs. Integrating rapid diagnostics, low-barrier telemedicine, and harm-reduction support may improve outcomes, as noted by researchers.
The clinical trial was identified with ClinicalTrials.gov Identifier NCT05466331, and follow-up for all participants was completed in September 2024. Further analysis of viral clearance rates is expected, but has not yet been publicly released.
