Bringing Hepatitis C Care to Rural Communities Through Mobile Telemedicine, With Peter Friedmann, MD, MPH

New research is shedding light on the potential utility of a mobile telemedicine-based intervention for hepatitis C virus (HCV) infection among rural persons who inject drugs.1

Findings from the randomized clinical trial showed telemedicine integrated with syringe services on a mobile van was associated with improved access to HCV treatment initiation and cure for people with a history of drug injection in rural communities where HCV treatment services are scarce.1

High rates of HCV infection among people who inject drugs are well described in urban settings, but far less is known about how to effectively reach affected individuals in rural communities. Additionally, previous work has demonstrated the benefits of embedding infectious disease screening within inpatient substance use disorder programs, highlighting increases in testing uptake and low-barrier delivery of preventive and therapeutic treatment among this vulnerable and difficult-to-reach patient population.1,2

In discussing his team’s work, Peter Friedmann, MD, MPH, a professor of quantitative health sciences at UMass Chan Medical School, explained how a 2-phase research project in northern New England sought to both define the problem and test a potential solution.

“This was in 2019 prior to the pandemic, so telemedicine was considered novel at the time, " Friedmann told HCPLive. “We were interested in whether you could deliver telemedicine from a van, and have the van go out to areas where there was high prevalence of injection use, since injection behavior and hep C sort of go together.”

Previously reported findings from the first phase of the research highlighted high hepatitis C seropositivity rates and prevalence of risky injection behaviors, underscoring the urgent need to improve access to sterile injection supplies, hepatitis C testing, and curative treatment in rural settings.

Friedmann further explained that the first phase revealed significant structural barriers to care, including limited access to phlebotomy and clinicians experienced in hepatitis C management. These gaps directly informed the design of the project’s second phase.

For that phase, he described how the mobile van traveled to areas with high rates of injection drug use, offering harm reduction services alongside telemedicine visits for hepatitis C evaluation and treatment. Participants were randomized either to this intervention or to what he termed “enhanced usual care,” which involved referral to local providers with care navigation support.

Results showed treatment initiation rates were higher in the mobile telemedicine group, with corresponding improvements in cure rates. Friedmann noted that while cure rates were similar among participants who attended their first appointment in either group, the key difference was getting patients started on therapy. Of note, his hypothesis that hepatitis C treatment would reduce syringe-sharing behaviors was not supported.

Friedmann additionally stressed that the success of the mobile model depended on more than the van itself. In his view, having a well-trained, nonjudgmental team experienced in working with this population was critical to supporting treatment initiation and completion in this high-risk, underserved group.

“There are a lot of treatment interruptions in this population, and this population really does require a lot of support in order to initiate and complete treatment,” he said. “Having workers, people are working on the van or working in the setting who are really familiar and comfortable and able to work in sort of a non-stigmatizing, non judgmental way with this population is really critical.”

Editors’ Note: Friedmann reports relevant disclosures with the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) and Indivior.

References

1. Friedmann PD, Wilson D, de Gijsel D, et al. Mobile Telemedicine for Treating Chronic Hepatitis C Among Rural People Who Inject Drugs: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(1):e2555125. doi:10.1001/jamanetworkopen.2025.55125

2. Brooks A. Infectious Disease Screening in Substance Use Treatment Programs Effective, Study Finds. HCPLive. August 7, 2025. Accessed February 9, 2026. https://www.hcplive.com/view/infectious-disease-screening-in-substance-use-treatment-programs-effective-study-finds