How Might Telehealth Benefit Persons Living With HIV?

In light of the coronavirus disease 2019 (COVID-19) pandemic, care for persons living with HIV (PWH) has become even more critical—especially considering that consistent retention in care can improve health outcomes and help to prevent transmission of the virus, according to a poster and abstract presented at the recent ID Week that looked at the use of telehealth among PWH.

“Several definitions exist for retention in care, but they are centered around outpatient clinic visits,” the authors note. “It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to-face clinic visits.”

This additional method of care can help to address some of the issues PWH may face when accessing care, such as transportation challenges, longer travel times to clinics, competing life events, and managing their infection, the poster noted.

To uncover these attitudes toward acceptability, benefits, and concerns about telehealth for HIV care, for the study period of February to June 2018, a survey was administered to current outpatients of an HIV center in Houston; their electronic medical records were also reviewed for viral load closest to the survey date and current antiretroviral treatment (ART) regimen. Among the 371 participants in this cross-sectional study, most were African American (63%), were born in the United States (83%), and acquired HIV through heterosexual transmission. Just over one-third (36%) were female, and the median (interquartile range) age was 51 (41-57) years.

Citing such advantages as telehealth being a good schedule fit (69%), decreased travel time (63%), and privacy (62%), an overall 57% (n = 211) of the respondents indicated a greater likelihood of using telehealth vs one-on-one in-person care if the former were offered. Meanwhile, 37% (n = 137) indicated they would use the service on a frequent basis, perhaps always, instead of visiting a clinic. Sixty-seven percent had undetectable viral loads, and 49% had been on ART for more than 10 years.

Additionally, 3 types of factors—personal, HIV-related, and structural—were used to evaluate the likelihood of using telehealth or the disinclination to do so. Those more likely to engage with telehealth were born in the United States, were men having sex with other men, and had a higher level of terminal education and higher perceived HIV-related stigma. Individuals less likely to utilize telehealth had long-standing HIV (>10 years), difficulty with in-person visits, and lack of appropriate technology.

Concerns expressed regarding switching to telehealth were lack of effective communication (23%) and a good physical examination (37%), along with the safety of online personal information (28%). Questions and statements to gauge both level of comfortableness and hesitation toward HIV included:

• If you can use live video call to see and talk to your doctor instead of coming to clinic appointments, how often would you use it?
• This service will be good for me because I will have more privacy at home.
• My doctor will not be able to examine me well.
• I will not be able to express myself very well.

Overall, there was a “positive attitude toward the use of telehealth for HIV care among PHW,” the authors noted. In fact, 52% retained their favorable opinion of telehealth despite still needing to pick up medications or present for laboratory tests in person.

“Telehealth programs for PWH can improve retention in care,” they concluded. “A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.”

Reference

Dandachi D, Dang B, Giordano TG. The attitude of patients with HIV about telehealth for their HIV care. Presented at: ID Week; October 21-25, 2020. Poster 1042.