Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil

Hoagland, Brenda; Torres, Thiago Silva; Bezerra, Daniel C.; Geraldo, Kim Mattos; Pimenta, Cristina; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1016/j.bjid.2020.05.004

Cited by 64 publications

(56 citation statements)

References 6 publications

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“…Interestingly, another study conducted in Brazil surveyed 11000 men who have sex with men and found only 44% expressed willingness to use HIV home testing for PrEP use and 87% expressed desire for follow-up consultation after test use. 14 Therefore, use of telemedicine can be used for PrEP care, but should be tailored to how comfortable the patient is with self-testing and willingness to use telemedicine.…”

Section: Resultsmentioning

confidence: 99%

Telemedicine for HIV Care: Current Status and Future Prospects

Smith¹,

Badowski²

2021

HIV

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Due to the COVID-19 pandemic, the use of telemedicine has been highlighted, especially in specialties, such as the management of HIV. Recent data were reviewed between January 1, 2019 and March 20, 2021 by searching English language manuscripts for studies documenting clinical outcomes in HIV care and the patient experience. A PubMed, Google Scholar, and bibliography review based on the search terms “HIV,” “telemedicine,” and “telehealth” was conducted. Studies included in this analysis were comprised of adult patients living with HIV, receiving care for HIV via telemedicine with reported clinical outcomes or perceptions of using telemedicine in the management of their HIV care. Of the 179 studies identified, 12 met inclusion for this analysis. Only two studies provided data on clinical outcomes of HIV (virologic outcomes), one pre-pandemic and one during COVID-19. The study evaluating viral suppression during COVID-19 demonstrated lower rates of virologic suppression and lower rates of missed appointments when shelter-in-place orders were issued compared to before the start of the pandemic. The remaining studies focused on patient-related outcomes as they related to the usability and adoption of telehealth models. Many practices documented the benefits and limitations of telemedicine based on the rapid switch from traditional in-person clinics. Benefits included retention in care for patients who lived a far distance from clinic, privacy for patients not wanting to be seen attending an HIV clinic, and more flexibility in scheduling appointments. Some limitations included patients’ access to technology, ability and willingness to use technology, and privacy of patients who are homeless and reside in a shelter where homelessness is 3 times greater in people living with HIV compared to the general population. Healthcare should be tailored to the individual patient by assessing their needs and limitations, particularly with patients who may be at risk for discontinuation of care, particularly in the homeless population. In addition, there are mixed data on factors such as age, sex, and race being limiting factors in willingness to use technology. From the studies reviewed, willingness to engage with technology did not differ by age, sex, or race but did differ by access and willingness to use technology. Greater limitations were access to appropriate devices for telemedicine and digital literacy. Although there have been difficulties with the switch to telemedicine in clinics during the COVID-19 pandemic, many patients have reported being satisfied with care and would be interested in continuing once the shelter-in-place order is lifted. Future studies should focus on the provision of HIV care using telemedicine beyond the pandemic and focus on ways to improve the telemedicine experience for the patient.

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Section: Resultsmentioning

confidence: 99%

Telemedicine for HIV Care: Current Status and Future Prospects

Smith¹,

Badowski²

2021

HIV

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“…Understanding these unprecedented challenges is key to informing strategies for seamless and high-quality telehealth services for HIV care during COVID-19 and thereafter [ 20 ]. Extant literature has described experiences and successful transformations of HIV prevention and care services via telehealth for sexual and gender minority populations in Rhode Island [ 12 ], pre-exposure prophylaxis (PrEP) and HIV home testing in Brazil [ 21 , 22 ] and also depicted barriers and challenges to telehealth in HIV care in New York [ 11 ]. However, there is limited knowledge on HIV care delivery through telehealth in the rural South.…”

Section: Introductionmentioning

confidence: 99%

“…Most previous studies on telehealth focus on medical HIV prevention and treatment services [ 11 , 12 , 21 , 22 ]. There is little known about non-medical HIV care services for PLWH including case management, housing, food, and transportation services during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Telehealth for HIV Care Services in South Carolina: Utilization, Barriers, and Promotion Strategies During the COVID-19 Pandemic

et al. 2021

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To ensure continuing HIV care services during the COVID-19 pandemic, telehealth has been recommended and implemented in numerous HIV-related facilities. This study aims to understand telehealth utilization for HIV care services in South Carolina (SC), identify barriers to telehealth during COVID-19, and investigate strategies to facilitate remote HIV care delivery. In-depth interviews with 11 management personnel from 8 HIV-related facilities in SC were analyzed using thematic analysis. Utilizations of telehealth were diverse in delivering medical and non-medical HIV care services. Barriers included technological challenges, digital literacy, client/provider experiences, low socio-economic status of client population, and reimbursement issues. Various strategies were mentioned for promoting telehealth utilization, from client empowerment, provider training to improved organizational readiness. For successful telehealth use during and after COVID-19, it is necessary to continue efforts to promote telehealth and remove barriers to telehealth by implementing inclusive multi-level strategies for non-technologically savvy or disadvantaged populations living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03349-y.

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“… 2 , 3 We have previously described telemedicine procedures for PrEP delivery adopted at Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz) in Rio de Janeiro, Brazil which included teleconsultation and provision of HIV self-testing (HIVST). 4 To understand the acceptability of PrEP teleconsultation and HIVST, we conducted a cross-sectional web-based study during social distancing period (April 16 to May 31, 2020), recruiting gay, bisexuals and other men who have sex with men (MSM) and transgender/non-binary (TGNB) individuals using a geosocial networking (GSN) app for sexual encounters (Hornet) and social media (Facebook and WhatsApp).…”

mentioning

confidence: 99%