Telemedicine for HIV Care: Current Status and Future Prospects

Abstract

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.

Perspectives of HIV specialists and cardiologists on the specialty referral process for people living with HIV: a qualitative descriptive study

“…Transportation challenges, including insufficient transportation infrastructure, have been found to be barriers to health services utilization for PLWH [ 39 , 40 ]. Innovative approaches are needed to reduce the burden of travel times and costs of transportation for PLWH who require cardiology care, including ride-sharing, telemedicine, or e-consults [ 41 , 42 ].…”

COVID-19 Telemedicine and Vaccination at an Urban Safety Net HIV Medicine Clinic

“… 10 Telemedicine, the use of information and communications technology to deliver digital health care services, was quickly embraced by clinics, hospitals, and insurance payers as COVID-19 spread around the world and severely limited face-to-face encounters in medical settings. 11 , 12 , 13 …”

Telehealth Interventions for HIV in Low- and Middle-Income Countries

“…1 ). A number of recent reviews have focused on HIV-related telehealth in high-income settings [ 5 •, 10 , 11 ], but experience in LMICs is less well described. We drew from peer-reviewed articles with a focus on data published from 2017 to 2022 to highlight key advances and knowledge gaps in translating telehealth to LMICs for HIV treatment and prevention.…”