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

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.