Trust, Access to Technology Among Important Factors for Virtual HIV Care

A study, published in JMIR Aging,¹ focused on interviewing older adults with HIV who use virtual care found that trust, access to technology, and privacy were all important factors that should be taken into consideration as virtual care expands in this population.

Health care delivery changed after the COVID-19 pandemic, prompting more usage of virtual care to provide health care to patients without putting them at risk. The CDC estimates that telehealth usage increased to 86.5% in 2021, indicating a high demand for the services.² Older adults are among the most prevalent beneficiaries of virtual care, as it allows them to receive the care they need without the need for traveling. Older adults with HIV fall under such a category as they require complex health care to cover all of their symptoms. This study aimed to collect the opinions and perceptions of older adults with HIV when it comes to virtual care, specifically in how supportive virtual care is, the perceived obstacles in virtual care, and how to improve it overall.

Older adults with HIV have various feelings on the use of telehealth in care, specifically in regards to privacy and technological access | Image credit: DC Studio - stock.adobe.com

Participants were eligible for this study if they were living in Ontario and if they were 50 years or older. Participants were recruited through social media, HIV clinics, health care facilities that catered to older individuals with HIV, and geriatric clinics. The researchers also targeted community-based organizations to ensure diversity in the cohort. Interviews with the participants were conducted either in person, via telephone, or through Zoom for Healthcare.

All interviews were conducted by either a trained research assistant or a peer researcher. An optional demographic form was also offered to all participants to fill out. All transcripts of the interviews were analyzed and organized after the interview concluded.

There were 14 participants included in this study, of which 10 were men. The mean (SD) age of the cohort was 63 (10) years. A total of 9 participants lived in an urban setting. There were 3 primary themes that came up during the interviews: importance of relationships in virtual care, privacy and confidentiality in virtual care, and access and technological barriers in virtual care.

The participants with strong relationships to their health care providers were the most comfortable sharing their health concerns and receiving help in managing their conditions, which makes having those primary care providers available through virtual care important for older adults who rely on it. Participants who did not trust their relationship with their provider were not as likely to adhere to their treatment or appointments. Participants were more willing to access other virtual care services if they had a consistent primary doctor.

Privacy was a big concern for participants as they felt that phone consultations would provide more anonymity and privacy compared with in-person appointments. This allowed for the participants to discuss more sensitive topics, such as sexual health, within a more comfortable space. However, other participants preferred in-person if they lived in close proximity to others, as in-person appointments would allow for more privacy away from family members. A general distrust of virtual care platforms due to their skepticism of ensuring secure and private information was also found in some participants. A fear of being considered geriatric was also a hinderance to registering.

Most of the participants felt discouraged from seeking health care in person after the COVID-19 pandemic. Access to a telephone or computer was available for most of the participants so that they could access virtual care, even if some of them had to share the technology with others. Virtual care allowed a reduction in time needed off of work to get the care they needed. However, internet connection, personal devices, lack of technological literacy, and not finding a secure location to use communal technology were concerns of the participants.

There were some limitations to this study. The generalizability of the results may be limited due to all participants being from Ontario and being 50 years or older. All participants had access to technology for virtual care. Most of the participants were younger than 60 years and had lived in Ontario for more than 10 years, which may not be representative of patients with HIV at large. Selection bias toward those engaged in health care services is possible due to outreach in community-based organizations. Health care providers and stakeholders were not included in this study. The long-term effect of virtual care was also not evaluated.

The researchers concluded that the results of the study “underscore the imperative of cultivating trusting relationships between health care providers and older adults living with HIV in virtual care settings,” which would make ensuring patient privacy a top priority. Developing inclusive virtual care models relies on collaboration between providers and policy makers to ensure patients get the care they need in a matter that is most comfortable for them and meets their needs.

References

1. Kokorelias KM, Valentine D, Dove EM, et al. Exploring the perspectives of older adults living with HIV on virtual care: qualitative study. JMIR Aging. 2024;7:e65730. doi:10.2196/65730
2. Myrick KL, Mahar M, DeFrances CJ. Telemedicine use among physicians by physician specialty: United States, 2021. CDC. February 2024. Accessed December 5, 2024. https://www.cdc.gov/nchs/products/databriefs/db493.htm