HIV Care Continuum Strained Under COVID-19 Pandemic

The substitution of telemedicine for many in-person HIV care–related services during the COVID-19 pandemic has produced mixed results, with persons living with HIV increasingly lost to follow-up despite patients and providers having favorable views of virtual care delivery, reports Current HIV/AIDS Reports.

With virologic suppression rates also dropping among some patient populations, the authors note that the pandemic may have exacerbated gaps already present in the HIV space.

“For many persons with HIV, the clinic serves as a medical home, and the pandemic has created substantial barriers to accessing primary care and other multidisciplinary services while trying to maintain safe physical distancing,” they state. Many clinics were also unprepared for such a quick 180 in how they delivered care and continue to troubleshoot these practices.

When the seriousness of the pandemic became apparent, CMS facilitated telemedicine’s expansion by issuing emergency waivers for easier implementation, HHS waived certain telemedicine restrictions, and private payers amended payment and prescription practices. Data were limited on telemedicine’s effectiveness in HIV care because it had not been implemented on a widespread basis. Previously, “regulatory and reimbursement barriers hindered telemedicine’s implementation and its use was limited to specific healthcare systems or unique situations and to research settings,” the study authors stated.

Previous study findings note such benefits as decreased travel time and expenses; increased patient satisfaction; higher screening rates for syphilis, depression, and tobacco and alcohol use; and more frequent viral load testing. But corresponding improvements in virologic suppression have not been seen, and in settings where pre-exposure prophylaxis (PrEP) is delivered, fewer men who have sex with men report testing for HIV or sexually transmitted infections and visits and prescriptions have both dropped.

These findings echo across several studies and various care settings (including PrEP), the authors note, with patients citing privacy, data breach, billing, and insurance concerns—even though they have positive experiences with video visits, including feeling more safe.

So, where to go from here, with such persistent issues as socioeconomic causes, not having the appropriate technology (a “digital divide,” the authors call it), and lack of privacy?

“Given that it is difficult to generalize from these studies alone and that communication with a provider is one of many elements necessary for patients to succeed with HIV treatment,” the authors say, “more data regarding virologic suppression and retention in care during this new telemedicine era are required.”

Initial planning also should be taking place for how to continue and improve telemedicine after the pandemic, temporary regulations supporting telemedicine should become permanent fixtures, and payment parity for both video- and telephone-based visits should be maintained, among other solutions.

“Telemedicine provides an exciting opportunity to tailor care to each individual patient, to avoid traditional ‘one-size-fits-all’ ambulatory care models, and to move toward delivering more innovative and differentiated care so that we may ultimately end the HIV epidemic,” the authors conclude.

Reference

Budak JZ, Scott JD, Dhanireddy S, Wood BR. The impact of COVID-19 on HIV care provided via telemedicine—past, present, and future. Curr HIV/AIDS Rep. 2021;1-7. doi:10.1007/s11904-021-00543-4