People Living With HIV Satisfied With Telemedicine During Pandemic

Patients living with HIV (PLHIV) residing in Los Angeles reported they would continue using telemedicine, specifically through telephone calls, in the future after high satisfactory ratings for the practice, according to a study published in BMC Infectious Diseases.¹

Telemedicine became more popular during the COVID-19 pandemic because many patients were unable or unwilling to go to the doctor in person due to fear of contracting SARS-CoV-2. PLHIV were among the patients who benefited from the pivot to telemedicine,² as their immunocompromised status leaves them vulnerable. However, the effectiveness of telemedicine in HIV care has been less researched compared with its use to bring care to patients with other chronic conditions. This study focused on 2 federally qualified health centers (FQHCs) in Los Angeles to evaluate the use of telemedicine among PLHIV during the COVID-19 pandemic.

People living with HIV found telemedicine to be satisfactory during the COVID-19 pandemic. | Image credit: rh2010 - stock.adobe.com

The study took place between March and November of 2022 in the FQHCs in south Los Angeles County’s Service Planning Area 6. All participants were 18 years or older, had received care for HIV for at least 3 months, and spoke either English or Spanish. Recruitment occurred during both in-person and telemedicine visits. All surveys were conducted either by telephone or in person for a maximum of 1 hour.

The telemedicine visits in the clinics started in March 2020. A health care visit that occurred between a patient and their clinician that took place over the telephone was defined as “telephone telemedicine” whereas “video telemedicine” was any health care visit that occurred over a video call.

There were 271 PLHIV who participated in the study, of which 79% identified as cisgender men. Their median (IQR) age was 49 (37-58) years. A total of 46% of the participants identified as Black and 26% identified as Hispanic or Latino. Seventy-nine percent reported high school or the General Educational Development test as the minimum education level; 52% reported being unemployed or on disability. The median length of time living with HIV was 12 (6-21) years, and median time on antiretroviral therapy (ART) was 10 (5-19) years. Among those who had blood drawn in the year before the survey, 69% were virally suppressed.

A total of 56% of the participants reported a telephone telemedicine visit and 4% reported a video visit. The quality of care of the telemedicine visits was satisfactory to most of the patients, with 95% feeling satisfied with telephone visits and 100% satisfied with video visits. Telemedicine was not frequently used outside of care for HIV, with 61% reporting they had no experience with telemedicine outside of HIV.

Most of the participants had consistent access to a telephone in the previous 3 months (95%), had reliable access to cellular data or Wi-Fi (97%), or owned a smartphone (95%). Less participants owned a laptop or tablet to use for a visit (58%), with 53% of those who did not own a tablet saying they would never be able to borrow a tablet. A total of 79% of those surveyed were the primary payers for their telephone plans and 55% were the provider for their Wi-Fi plan.

Most of the participants felt that telemedicine could or would save them time (86%) and money (79%), and felt they were not more likely to miss an appointment if it was a telemedicine appointment rather than in person (61%). A total of 70% felt that telemedicine was more convenient compared with in-person visits. Telemedicine appointments were more often cited as convenient in patients who had a grade school level of education or who preferred Spanish as their primary language. Patients 45 years or older were more likely to cite in-person appointments as convenient compared with younger patients (28% vs 17%). A total of 82% preferred video calls, especially patients identifying as a woman or who had a grade school level of education. Most of the participants preferred a mix of telemedicine and in-person visits (71%).

There were some limitations to this study. All of the participants were PLHIV who were engaged in their own care, so the findings are not generalizable to PLHIV generally. Differences in attitudes toward telemedicine based on language spoken could only be evaluated with limited power due to the smaller sample size, and approximately 40% of the participants responded to the questions in the hypothetical due to not using telemedicine in the past. In addition, technological literacy was self-reported, so it could be biased; the relationship between the duration on ART and attitudes toward telemedicine were not evaluated; and clinical outcomes like engagement, retention, and viral load suppression were not evaluated when accounting for improvements from telemedicine.

The researchers concluded that PLHIV were satisfied with the telemedicine offered to them through their FQHCs in Los Angeles.

“Respondents expressed high interest in using telemedicine for future HIV care, including video visits,” the authors wrote. “While individuals raised concerns about certain challenges with telemedicine…they found that telemedicine made it easier to make their appointments on time and saved them time and money.”

References

1. Walker D, Moucheraud C, Butler D, et al. Telemedicine for HIV care: a cross-sectional survey of people living with HIV receiving care at two federally qualified health centers in Los Angeles during the mature phase of the COVID-19 pandemic. BMC Infect Dis. 2024;24(1):1481. doi:10.1186/s12879-024-10351-x

2. Krause KD, Karr AG, Aggarwal J, et al. Assessing the disruption of health services during the COVID-19 pandemic among adults living with HIV by age in Essex County, NJ: a cross-sectional study. J Assoc Nurses AIDS Care. 2024;35(6):544-555. doi:10.1097/JNC.0000000000000499