# Synchronous Telemedicine Versus In‐Person Care in Hepatitis C Treatment: A Systematic Review and Meta‐Analysis

## TL;DR

This study compares telemedicine with in-person care for treating hepatitis C and finds similar effectiveness, with telemedicine showing benefits in rural and marginalized populations.

## Contribution

The paper provides a systematic review and meta-analysis on the effectiveness of synchronous telemedicine for HCV treatment compared to in-person care.

## Key findings

- Synchronous telemedicine showed no significant difference in sustained virologic response compared to in-person care.
- Telemedicine had context-specific advantages in rural settings and randomized controlled trials.
- Narrative evidence suggests telemedicine benefits marginalized groups and reduces costs.

## Abstract

Inequitable access to HCV treatment persists, particularly for rural and marginalised populations. Synchronous telemedicine (TM) could mitigate access barriers, but its comparative effectiveness versus in‐person care is uncertain. We performed a systematic review and meta‐analysis comparing synchronous TM with in‐person care for HCV. The primary outcome was sustained virologic response (SVR); secondary outcomes were treatment initiation and completion. Subgroup analyses examined study design, therapy era (interferon vs. direct‐acting antivirals [DAAs]), and setting (rural vs. non‐rural). Narrative synthesis addressed people who use drugs (PWUD), incarcerated populations, pandemic‐era cohorts, and economic evaluations. Fifteen studies involving 7.459 patients (2 RCTs, 13 observational) were included (13 meta‐analysed). For SVR, the pooled effect showed no significant difference between interventions (odds ratio [OR] 1.60, 95% CI 0.69–3.68). Treatment initiation and completion were also not significantly different overall (initiation OR 7.59, 95% CI 0.79–72.81; completion OR 2.50, 95% CI 0.76–8.25), although exclusion of single influential studies yielded significant benefits for TM in sensitivity analyses. Subgroups suggested context‐specific advantages: TM favoured SVR in rural settings (OR = 4.19, 95% CI 1.28–13.73) and in RCTs (OR = 10.42, 95% CI 7.41–14.67). Narrative evidence indicated that TM improved linkage and cure among PWUD and incarcerated individuals, preserved efficacy during COVID‐19, and reduced costs. Overall, synchronous TM seems comparable to in‐person care overall and may be superior in rural and marginalised populations.