Telemedicine Effective at Care Retention Among Rural Patients Living With HIV - AJMC.com Managed Markets Network

Noting the difficulty persons living with HIV have at being retained in care, especially when presented with social, geographical, health system, and economic barriers, researchers from Medical College of Georgia, Massachusetts General Hospital, and Harvard Medical School investigate telemedicine’s impact in the space.

“Telemedicine is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional care in rural populations,” they wrote. “The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model.”

Study participants were patients from the Dublin Department of Health HIV clinic database (n = 185; the TM cohort) and the August University HIV clinic patient database (n = 200; the F2F cohort) who were enrolled andhad visits between May 2017 and April 2018. They were matched 1:1 for gender, age, and race. Mann-Whitney U and t tests compared viral loads (VLs) and CD4 counts.

While the CD4 count was shown to be lower in the F2F cohort compared with the TM cohort—596.3 vs 643.9 cells/mm3 (P < .001)—the results were close to equal for those with a detectable VL at baseline who achieved viral suppression: 44% and 45%, respectively. The mean changes in VL to achieve viral suppression were 3.34 x 104 and –1 to 0.24 x 104.

Statistically significant differences in VL reduction, control, and mean VL were not seen, coming in at 416.8 cp/mL for the F2F cohort and 713.4 cp/mL (P < .001) for the TM cohort.

Primary study outcomes were rates of viral suppression and maintenance of it.

The authors highlighted how some patients have to travel 3 or 4 hours, one way, to access necessary care and that “travel time to access health care has been shown to reduce the use of specialty care in rural-dwelling veterans and to impact their health negatively.” This can have an especially hard impact on the South, where in 2018 alone, new HIV diagnoses outpaced the national average 18.4% to 13.3% per 100,000 individuals. Higher rates of nonadherence and poor retention care are also seen in Southern states.

Analyses also found:

• Most patients in the F2F (82.0%) and TM (82.2%) cohorts were Black
• Patients in both groups were 51 years or older (51.0%, F2F; 53.5%, TM)]
• Medication remained the same for most patients during the study period (81.0%, F2F; 85.4%, TM)
• The top 3 most common comorbidities in the F2F group were cardiac (58.5%), neuropsychiatry (37.5%), and stage 3-5 chronic kidney disease (CKD; 31.5%)
• The top 3 most common comorbidities in the TM group were cardiac (29.7%), stage 3-5 CKD (17.8%), and neuropsychiatry (17.3%)
• Year-round viral suppression was similar among the groups, at 77% for patients receiving TM care and 73% receiving F2F care
• Mean VL suppression change was –8.16 x 102 for the TM cohort and –3.51 x 102 for the F2F cohort (P = .26)

“The results of this study are consistent with previous studies that have examined HIV outcomes when care is delivered through telemedicine by HIV-trained physicians as compared with the F2F clinic,” the authors concluded. “The unique telemedicine model makes it easier for physicians and other HIV-trained providers to deliver the same quality of care without the restrictions of geography, travel, or time.”

Future studies, with rigorous study design, should evaluate different modalities of TM for their effectiveness and acceptability among physicians and patients.

Reference

Lawal FJ, Omotayo MO, Lee TJ, Rao ASR, Vazquez JA. HIV treatment outcomes in rural Georgia using telemedicine. Open Forum Infect Dis. Published online May 12, 2021. doi:10.1093/ofid/ofab234

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