Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State

Abstract

Background Older persons living with HIV (PLWH) need routine healthcare to manage HIV and other comorbidities. This mixed methods study investigated digital equity, constituted as access, use and quality, of HIV and specialty telehealth services for PLWH > 50 years during the initial wave of the COVID-19 pandemic when services transitioned to remote care. Methods A survey of closed and open-ended questions was administered to 80 English (N = 63) and Spanish (N = 17) speaking PLWH receiving HIV care at an Academic Medical Center (N = 50) or a Federally Qualified Health Center (N = 30) in New York State. Quantitative analyses examined characteristics predicting telehealth use and visit quality. Qualitative analyses utilized thematic coding to reveal common experiences. Results were integrated to deepen the interpretation. Results Telehealth access and use were shaped by multiple related and unstable factors including devices and connectivity, technology literacy, and comfort including privacy concerns. Participants demonstrated their substantial effort to achieve the visit. The majority of patients with a telehealth visit perceived it as worse than an in-person visit by describing it as less interpersonal, and resulting in poorer outcomes, particularly participants with less formal education. Technology was not only a barrier to access, but also influenced perceptions of quality. Conclusions In the COVID-19 pandemic initial wave, barriers to using telehealth were unequally distributed to those with more significant access and use challenges. Beyond these barriers, examining the components of equity indicate further challenges replicating in-person care using telehealth formats for older PLWH. Work remains to establish telehealth as both equitable and desirable for this population.

HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges

“…For instance, one New York study found that PWH 50 years or older described telehealth as “too negative” for having fewer interpersonal components, particularly patient-provider relationship elements. Also, participants in the New York study with less formal education that utilized telehealth had poorer health outcomes than patients with high educational levels [ 45 ]. Similarly, in another study, racial minority telehealth users, particularly African Americans, had higher odds of unsuppressed viral loads than other racial or ethnic groups who utilized telehealth [ 13 ].…”

“…A persistent and significant concern regarding telehealth utilization among patients is the issue of data security [ 26 , 42 , 45 , 49 ]. Consistently reported in the literature, patients are concerned about the breach of data.…”

Role of Visit Modality in the HIV-Related No-Shows During the COVID-19 Pandemic: A Multisite Retrospective Cohort Study

“…When examining telephone visits, younger versus older and Black versus “Other” race PWH were more likely to have a no-show. In line with this, a qualitative study exploring experiences associated with telehealth use among older PWH (> 50 years) found older individuals to prefer telephone visits over video visits [ 20 ]. These results, which illustrate more sociodemographic differences in retention in care outcomes for in-person versus telehealth visits, suggest that telehealth visits may help ameliorate some of the structural barriers that contribute to health disparities.…”

Access to care through telehealth among U.S. Medicare beneficiaries in the wake of the COVID-19 pandemic

“…Radhakrishnan et al ( 43 ) reported that for patients with heart failure on telehealth, comorbidity characteristics of renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth services. However, a more recent study showed that for older persons living with HIV, the number of comorbidities was positively related to telehealth use via telehealth apps such as the MyChart App ( 44 ). Because of risk factors for severe COVID-19, the role of telehealth use will become more and more critical for the early identification of patients who need their care, care coordination, and the assessment of daily facility needs.…”