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Dunn RC, Stegall CJ, Creel C, Fuchs CJ, Menzies BE, Summers NA. Evaluating the delivery of care by telemedicine for incarcerated people living with HIV: a cohort study. BMC Infect Dis 2024; 24:717. [PMID: 39039476 PMCID: PMC11265178 DOI: 10.1186/s12879-024-09528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The use of telemedicine has grown significantly since the COVID-19 pandemic and has the potential to improve access to specialized care for otherwise underserved populations. Incarcerated people living with HIV (PLWH) could potentially benefit from expanded access to HIV care through telemedicine. METHODS All PLWH who were incarcerated within the Tennessee Department of Corrections and received care through the HIV telemedicine clinic at Regional One Hospital between 5/1/2019 through 2/28/2022 were identified from the electronic health records (EHR). Demographics, laboratory data, vaccine history, and treatment outcomes were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions. RESULTS Of the 283 incarcerated PLWH receiving care from this telemedicine clinic, 78% remained retained in care and 94% achieved or maintaining viral suppression at 12 months. Many preventative care measures remained unperformed or undocumented, including vaccinations and testing for concurrent sexually transmitted infections. There were 56 patients (20%) found to have chronic hepatitis C in this population, with 71% either cured or still on treatment in this study period. CONCLUSIONS Retention in care and viral suppression rates were excellent among incarcerated PLWH receiving telemedicine care for their HIV. HIV related primary health care screenings and vaccinations, however, were less consistently documented and represent areas for improvement.
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Affiliation(s)
- Ruth C Dunn
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Cassidy J Stegall
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Colten Creel
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Christian J Fuchs
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Barbara E Menzies
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathan A Summers
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.
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Yelverton V, Ostermann J, Natafgi N, Olatosi B, Weissman S, Albrecht H. Disparities in Telehealth Use in HIV Care During the COVID-19 Pandemic: Study Findings from South Carolina. Telemed J E Health 2024; 30:1594-1599. [PMID: 38350120 PMCID: PMC11296154 DOI: 10.1089/tmj.2023.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 02/15/2024] Open
Abstract
Background: Telehealth was adopted to maintain HIV care continuity during the COVID-19 pandemic; however, its use was unequally distributed. This study examined variation in HIV care visit patterns and whether telehealth use was associated with viral suppression. Methods: Electronic health record (EHR) data from a large HIV clinic in South Carolina was analyzed using multivariable logistic regression to characterize variation in telehealth use, having a viral load (VL) test, and viral suppression in 2022. Results: EHR data from 2,375 people living with HIV (PWH) between March 2021 and March 2023 showed telehealth use among 4.8% of PWH. PWH who are 50+ years and non-Hispanic Black had lower odds of telehealth use (odds ratio [OR] 0.59, 95% confidence interval [CI 0.40-0.86]; OR 0.58, 95% CI [0.37-0.92] respectively). Telehealth use was not associated with viral suppression and VL testing. Conclusion: Telehealth disparities in HIV care affected older and non-Hispanic Black PWH, requiring tailored strategies to promote telehealth among them.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Infectious Diseases, Prisma Health Columbia, South Carolina, USA
| | - Helmut Albrecht
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Infectious Diseases, Prisma Health Columbia, South Carolina, USA
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Yelverton V, Gass SJ, Amoatika D, Cooke C, Ostermann J, Natafgi N, Hair NL, Olatosi B, Owens OL, Qiao S, Li X, Derrick C, Weissman S, Albrecht H. The Future of Telehealth in Human Immunodeficiency Virus Care: A Qualitative Study of Patient and Provider Perspectives in South Carolina. AIDS Patient Care STDS 2023; 37:459-468. [PMID: 37862076 PMCID: PMC10616939 DOI: 10.1089/apc.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
To ensure care continuity during the COVID-19 pandemic, telehealth has been widely implemented in human immunodeficiency virus (HIV) care. However, participation in and benefits from telehealth were unequal. This study aims to assess the willingness of people living with HIV (PWH) and HIV care providers to use telehealth and perceptions of the future role of telehealth. In-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed their willingness to use telehealth, their perspectives on the future of telehealth in HIV care, and recommendations to improve telehealth. Interviews were analyzed using thematic analysis. Most PWH were female (61%), Black/African American (67%), and non-Hispanic (78%). Most PWH (61%) and all providers had used telehealth for HIV care. Most PWH and all providers reported being willing to use or (re-)consider telehealth HIV care services in the future. Providers suggested that telehealth is most suitable for routine HIV care encounters and for established, clinically stable, generally healthy PWH. Attitudes toward telehealth were heterogeneous, with most interviewees valuing telehealth similarly or superior to in-person care, yet >20% perceiving it less valuable. Recommendations to improve telehealth included multilevel strategies to address challenges across four domains: technology, the virtual nature of telehealth, administrative processes, and the sociodemographic profile of PWH. Telehealth in HIV care is here to stay; however, it may not yet be suitable for all PWH and all care encounters. Decision processes related to telehealth versus in-person care need to involve providers and PWH. Existing telehealth options require multilevel adjustments addressing persistent challenges.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Salome-Joelle Gass
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Christopher Cooke
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Otis L. Owens
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Caroline Derrick
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Helmut Albrecht
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
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