Shlomit Yaron, Ronen Arbel, Yafa Ashur, Talish Razi
Hybrid care pathways were independently associated with substantially higher DAA completion than either in-person or telemedicine alone. Telemedicine on its own conferred no measurable advantage. HCV elimination programs should embed structured hybrid pathways and pair them with targeted adherence support for older patients and patients with drug-use disorders.
BACKGROUND: Direct-acting antivirals (DAAs) cure more than 95% of hepatitis C virus (HCV) infections, shifting the principal barrier to elimination from drug efficacy to patient engagement and adherence. Telemedicine is generally non-inferior to in-person care for HCV management, but most evidence treats care modalities as mutually exclusive and does not address how their integration in routine practice affects treatment completion. The objective or this work was to evaluate the association between care-modality patterns: in-person only, telemedicine only, or hybrid, and DAA medication adherence among adults treated for HCV in routine care.
METHODS: We conducted a retrospective cohort study of adults with HCV treated with DAAs between January 1, 2015, and December 31, 2024 within Clalit Health Services. Patients were classified by care pathway as in-person, telemedicine, or hybrid. The primary outcome was completion of a full DAA treatment course based on pharmacy dispensing records. Associations were estimated with multivariable logistic regression adjusted for sex, age group, population sector, and drug-abuse diagnosis.
RESULTS: Of 7,295 patients analyzed (36% in-person only, 7.6% telemedicine only, 56% hybrid), overall treatment completion was 69%: 64% with in-person care, 61% with telemedicine, and 74% with hybrid care. In adjusted analyses, telemedicine alone was similar to in-person care (adjusted odds ratio [aOR] 0.93, 95% confidence interval [CI] 0.77-1.13, p = 0.4). Hybrid care was independently associated with higher completion than in-person care (aOR 1.67, 95% CI 1.50-1.86, p < 0.001).
CONCLUSIONS: Hybrid care pathways were independently associated with substantially higher DAA completion than either in-person or telemedicine alone. Telemedicine on its own conferred no measurable advantage. HCV elimination programs should embed structured hybrid pathways and pair them with targeted adherence support for older patients and patients with drug-use disorders.