Experiences with Telemedicine for HIV Care During the COVID-19 Pandemic: A Mixed-Methods Study

Abstract

To characterize perspectives and experiences with telemedicine during the COVID-19 pandemic, we conducted a mixed-methods study in two HIV clinics in the US Northeast. Among surveyed patients with HIV (PWH) who had a telemedicine appointment (n = 205), 42.4% perceived telemedicine visits as useful during the pandemic. PWH and clinical staff identified benefits of telemedicine: (1) ability to engage and re-engage patients in care; (2) perceived patient-centeredness and flexibility; (3) opportunity to engage family and multidisciplinary care team members; and (4) opportunity to enhance telemedicine use proficiency through practice and support. Identified barriers included: (1) technical challenges; (2) privacy concerns; (3) loss of routine clinical experiences and interactions; (4) limited objective patient remote monitoring; and (5) reimbursement concerns. Efforts to optimize telemedicine for HIV care should consider strategies to improve technology support for PWH, flexible options to access care, additional platforms to allow patient remote monitoring, and appropriate billing and reimbursement methods. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03556-7.

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

“…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.…”

The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil

“…In the context of caring for COVID-19, telemedicine was used more by physicians in hospitals (public and private) and in private practices and outpatient clinics, and only by a minority of primary care physicians. In Brazil, as in other LMICs, there will be a need to improve the legislation and regulation of the use of telemedicine [ 41 ], as well as a need to review human, structural, political and institutional capabilities for the better use of this technology [ 42 ].…”

Telemedicine Use Among People with HIV in 2021: The Hybrid-Care Environment

“…That said, our findings are largely consistent with data from multiple studies conducted earlier in the pandemic. 14,15,17,21,32 Several groups were less likely to use telemedicine generally and video visits specifically, including older patients and Black patients. While survey data suggest that attitudes towards telemedicine use do not differ across these demographics, 33 it is hypothesized that this disparity is a consequence of the “digital divide”, 21,32 structural factors that result in differential computer access, internet access and technological literacy which disproportionately impact older patients and racial minorities.…”

“…[10][11][12][13] At the onset of the COVID-19 pandemic, telemedicine emerged as the primary means of engaging people with HIV (PWH), to mitigate SARS-COV-2 exposure. [14][15][16][17][18] Later in the pandemic, most clinics resumed more onsite visits and offered a mixture of in-person and telemedicine care, 15 creating an opportunity to study telemedicine's potential as a tool for long-term engagement in a hybrid care environment.…”

“…14,16 However, telemedicine uptake varied across demographic subgroups and a significant portion of patients were limited to using telephone-only encounters. 14,15,17,18,23 Additional data to determine whether these early pandemic trends persisted are needed.…”