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Saragih ID, Tonapa SI, Osingada CP, Porta CM, Lee BO. Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies. J Telemed Telecare 2024; 30:438-450. [PMID: 34967240 DOI: 10.1177/1357633x211070726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | | | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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2
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Cuadros DF, Huang Q, Mathenjwa T, Gareta D, Devi C, Musuka G. Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery. Front Digit Health 2024; 6:1278223. [PMID: 38500968 PMCID: PMC10944905 DOI: 10.3389/fdgth.2024.1278223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Diego F. Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Thulile Mathenjwa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Chayanika Devi
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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Barth SK, Saulters KJ, Balba GP, Monroe AK, Horberg MA, Kumar PN, Greenberg AE, Castel AD. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 2024; 28:912-923. [PMID: 37872460 PMCID: PMC10923106 DOI: 10.1007/s10461-023-04198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.
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Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
| | - Kacie J Saulters
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
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Kokorelias KM, Grosse A, Zhabokritsky A, Sirisegaram L. Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis. BMC Geriatr 2023; 23:417. [PMID: 37422631 PMCID: PMC10329351 DOI: 10.1186/s12877-023-04114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Advances in Human Immunodeficiency Virus (HIV) treatment have reduced mortality rates and consequently increased the number of individuals with HIV living into older age. Despite this, people aged 50 years and older have been left behind in recent HIV treatment and prevention campaigns, and a gold-standard model of care for this population has not yet been defined. Developing evidence-based geriatric HIV models of care can support an accessible, equitable, and sustainable HIV health care system that ensures older adults have access to care that meets their needs now and in the future. METHODS Guided by Arksey & O'Malley (2005)'s methodological framework, a scoping review was conducted to determine the key components of, identify gaps in the literature about, and provide recommendations for future research into geriatric models of care for individuals with HIV. Five databases and the grey literature were systematically searched. The titles, abstracts and full texts of the search results were screened independently in duplicate. Data were analyzed using a qualitative case study and key component analysis approach to identify necessary model components. RESULTS 5702 studies underwent title and abstract screening, with 154 entering full-text review. 13 peer-reviewed and 0 grey literature sources were included. Most articles were from North America. We identified three primary model of care components that may improve the successful delivery of geriatric care to people living with HIV: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. Most articles included some aspects of all three components. CONCLUSION To provide effective geriatric care to older persons living with HIV, health services and systems are encouraged to use an evidence-based framework and should consider incorporating the distinct model of care characteristics that we have identified in the literature. However, there is limited data about models in developing countries and long-term care settings, and limited knowledge of the role of family, friends and peers in supporting the geriatric care of individuals living with HIV. Future evaluative research is encouraged to determine the impact of optimal components of geriatric models of care on patient outcomes.
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Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160 - 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Division of Geriatric Medicine, Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Alice Zhabokritsky
- Department of Medicine, Medical Sciences Building, The University of Toronto, King's College Cir, Toronto, ON, M5S 1A8, Canada
- Infectious Diseases, Department of Medicine, University Health Network, 610 University Ave, Toronto, Toronto, ON, M5G 2M9, Canada
- CIHR Canadian HIV Trails Network, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Luxey Sirisegaram
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
- Division of Geriatric Medicine, Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
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Sternberg CA, Jackyvens C, Jean RM, Chery MJ, Batalien B, Maddy K, Richard D, Duthely LM, Botero V, Rodriguez A, Boulanger C, Blanc J, Bartholomew TS, Tookes HE, Dale SK, Alcaide ML. Viv Byen (Live Well): A Qualitative Pilot Study to Assess Telehealth Use for HIV Care Among People of Haitian Descent. AIDS Patient Care STDS 2023; 37:279-283. [PMID: 37205862 PMCID: PMC10280212 DOI: 10.1089/apc.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Affiliation(s)
- Candice A. Sternberg
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Camille Jackyvens
- Department of Obstetrics and Gynecology, Mirebalais University Hospital, Mirebalais, Haiti
| | | | - Maurice Junior Chery
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Blonsky Batalien
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Krisna Maddy
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Danelle Richard
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lunthita M. Duthely
- Department of Obstetrics and Gynecology, and University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valeria Botero
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan Rodriguez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Catherine Boulanger
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Judite Blanc
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tyler S. Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hansel E. Tookes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Maria L. Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Obstetrics and Gynecology, and University of Miami Miller School of Medicine, Miami, Florida, USA
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Carson H, Wang KH, Paek H, Hoffman P, Arakaki A, Gonzalez-Colaso R, Barakat LA, Villanueva M, Womack JA. Equity and use of telehealth modalities among people living with HIV during the COVID-19 pandemic. Digit Health 2023; 9:20552076231218840. [PMID: 38107977 PMCID: PMC10722925 DOI: 10.1177/20552076231218840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background COVID-19 forced a rapid transition to telehealth. Little is known about the use of telephone versus video visits among people living with or at risk for HIV (PWH). Setting We studied electronic health record data from an urban HIV clinic. Our sample included visit- and person-level data. Visit-level data came from appointments scheduled from 30 March 2020 to 31 May 2020. Person-level data came from patients 18+ years of age who completed at least one telephone or video visit during the period of interest. Methods We performed a cross-sectional analysis. Our primary outcome was telehealth modality (telephone or video). We compared visit completion status by telehealth modality. We evaluated associations between patient characteristics and telehealth modality using logistic regression. Results In total, 1742 visits included information on telehealth modality: 1432 telephone (82%) and 310 (18%) video visits. 77% of telephone visits were completed compared to 75% of video visits (p = 0.449). The clinic recorded 643 completed telehealth visits in April and 623 in May 2020. The proportion of telephone visits decreased from 84% in April to 79% in May (p = 0.031). Most patients participated in telephone versus video visits (415 vs. 88 patients). Older age (adjusted odds ratio [AOR] 3.28; 95% confidence interval [CI], 1.37-7.82) and Black race (AOR 2.42; 95% CI, 1.20-4.49) were positively associated with telephone visits. Patient portal enrollment (AOR 0.06; 95% CI, 0.02-0.16) was negatively associated with telephone visits. Conclusion PWH used telephone more than video visits, suggesting that telephone visits are a vital healthcare resource for this population.
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Affiliation(s)
- Hannah Carson
- Yale School of Medicine and Yale Physician Associate Program, New Haven, CT, USA
| | - Karen H. Wang
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Hyung Paek
- Yale School of Medicine and Yale School of Public Health, Department of Biostatistics, New Haven, CT, USA
| | - Pamela Hoffman
- Yale School of Medicine, Child Study Center, New Haven, CT, USA
| | - Andrew Arakaki
- Yale School of Public Health, Department of Chronic Disease Epidemiology New Haven, CT, USA
| | | | - Lydia A Barakat
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Julie A Womack
- VA Connecticut Healthcare System and Yale School of Nursing, West Haven, CT, USA
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7
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Quinn K, John S, Hirshfield S, Algiers O, O'Neil A, Petroll A, Walsh J. Challenges to meeting the HIV care needs of older adults in the rural South. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100113. [PMID: 36620181 PMCID: PMC9815493 DOI: 10.1016/j.ssmqr.2022.100113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.
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Affiliation(s)
- K.G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S.A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S. Hirshfield
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
| | - O. Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - A. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, United States
| | - A.E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - J.L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
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Valentine JA, Mena L, Millett G. Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention. Sex Transm Dis 2022; 49:S36-S40. [PMID: 36219706 DOI: 10.1097/olq.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.
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Affiliation(s)
- Jo A Valentine
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leandro Mena
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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9
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Stephenson R, Sullivan SP, Mitchell JW, Johnson BA, Sullvian PS. Efficacy of a Telehealth Delivered Couples' HIV Counseling and Testing (CHTC) Intervention to Improve Formation and Adherence to Safer Sexual Agreements Among Male Couples in the US: Results from a Randomized Control Trial. AIDS Behav 2022; 26:2813-2824. [PMID: 35194698 PMCID: PMC8863094 DOI: 10.1007/s10461-022-03619-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/04/2022]
Abstract
This paper reports the results of a randomized controlled trial (RCT) to assess the efficacy of Nexus, a telehealth delivered intervention that combines Couples' HIV counseling and testing (CHTC) with home-based HIV-testing, examining the impact of the intervention on the couples' formation and adherence to safer sexual agreements. Between 2016 and 2018, 424 couples were recruited online from the U.S and randomized to the intervention arm (a telehealth delivered CHTC session with two home HIV-testing kits) or a control arm (two home HIV-testing kits), with study assessments at baseline, 3 and 6 months. Outcomes were the formation and adherence to safer sexual agreements, dyadic discordance in sexual agreements, breakage of sexual agreements, and perceptions of PrEP. Couples in the intervention arm had significantly greater odds of reporting a safer sexual agreement (3 months OR 1.87, p-value 0.005, and 6 months OR 1.84, p-value 0.007), lower odds of reporting discordant sexual agreements at 6 months (OR 0.62, p-value 0.048), and a significantly lower odds of reporting breaking their sexual agreement (3 months OR 0.51, p-value 0.035, and 6 months OR 0.23, p-value 0.000). By 6 months, couples in the intervention arm were less likely to say PrEP was beneficial to one (RRR 0.33, P = 0.000) or both of them (RRR 0.29, P = 0.000) than being beneficial to neither of the partners. The high levels of acceptability and efficacy of the intervention demonstrate strong potential for the scale-up of this efficacious intervention that is delivered through a low-cost telehealth platform.
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Affiliation(s)
- Rob Stephenson
- The Center for Sexuality and Health Disparities, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Stephen P Sullivan
- The Center for Sexuality and Health Disparities, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Brent A Johnson
- Department of Biostatistics and Computional Biology, University of Rochestor Medical Center, Rochester, NY, USA
| | - Patrick S Sullvian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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11
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Experiences with Telemedicine for HIV Care During the COVID-19 Pandemic: A Mixed-Methods Study. AIDS Behav 2022; 26:2099-2111. [PMID: 35064390 PMCID: PMC8782707 DOI: 10.1007/s10461-021-03556-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/14/2022]
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.
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12
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Trepka MJ, Ward MK, Ladner RA, Sheehan DM, Li T, Ibarra C, Gbadamosi SO, Ibañez GE, Jean-Gilles M. HIV Care Access During the COVID-19 Pandemic as Perceived by Racial/Ethnic Minority Groups Served by the Ryan White Program, Miami-Dade County, Florida. J Int Assoc Provid AIDS Care 2022; 21:23259582221084536. [PMID: 35243926 PMCID: PMC8899832 DOI: 10.1177/23259582221084536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
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Lawal FJ, Omotayo MO, Lee TJ, Srinivasa Rao ASR, Vazquez JA. HIV Treatment Outcomes in Rural Georgia Using Telemedicine. Open Forum Infect Dis 2021; 8:ofab234. [PMID: 34104669 PMCID: PMC8180244 DOI: 10.1093/ofid/ofab234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics. Results Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P = 1.00). Conclusions TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.
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Affiliation(s)
- Folake J Lawal
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Moshood O Omotayo
- Centre for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tae Jin Lee
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Arni S R Srinivasa Rao
- Laboratory for Theory and Mathematical Modeling, Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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14
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https://doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https:/doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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16
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine-Past, Present, and Future. Curr HIV/AIDS Rep 2021; 18:98-104. [PMID: 33616811 PMCID: PMC7898490 DOI: 10.1007/s11904-021-00543-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
Purpose of Review This review summarizes HIV care delivered via telemedicine before and during the COVID-19 pandemic and highlights areas of study to inform optimal usage of telemedicine in HIV clinical practice in the future. Recent Findings To address barriers to care created by the COVID-19 pandemic, regulatory agencies and payors waived longstanding restrictions, which enabled rapid expansion of telemedicine across the country. Preliminary data show that providers and persons with HIV (PWH) view telemedicine favorably. Some data suggest telemedicine has facilitated retention in care, but other studies have found increasing numbers of PWH lost to follow-up and worsened virologic suppression rates despite offering video and/or telephone visits. Summary The COVID-19 pandemic has exacerbated gaps in the HIV care continuum. To help mitigate the impact, most clinics have adopted new virtual care options and are now evaluating usage, impact, and concerns. Further research into the effects of telemedicine on HIV care and continued work towards universal access are needed.
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Affiliation(s)
- Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA.
| | - John D Scott
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
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Grewal US, Terauchi S, Beg MS. Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic. JMIR Cancer 2020; 6:e20288. [PMID: 33049695 PMCID: PMC7717893 DOI: 10.2196/20288] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/27/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
It has been reported that the incidence of SARS-CoV-2 infection is higher in patients with cancer than in the general population and that patients with cancer are at an increased risk of developing severe life-threatening complications from COVID-19. Increased transmission and poor outcomes noted in emerging data on patients with cancer and COVID-19 call for aggressive isolation and minimization of nosocomial exposure. Palliative care and oncology providers are posed with unique challenges due to the ongoing COVID-19 pandemic. Telepalliative care is the use of telehealth services for remotely delivering palliative care to patients through videoconferencing, telephonic communication, or remote symptom monitoring. It offers great promise in addressing the palliative and supportive care needs of patients with advanced cancer during the ongoing pandemic. We discuss the case of a 75-year-old woman who was initiated on second-line chemotherapy, to highlight how innovations in technology and telehealth-based interventions can be used to address patients’ palliative and supportive care needs in the ongoing epidemic.
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Affiliation(s)
- Udhayvir Singh Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Stephanie Terauchi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Muhammad Shaalan Beg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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18
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Dandachi D, Freytag J, Giordano TP, Dang BN. It is Time to Include Telehealth in Our Measure of Patient Retention in HIV Care. AIDS Behav 2020; 24:2463-2465. [PMID: 32337650 PMCID: PMC7183926 DOI: 10.1007/s10461-020-02880-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, MO, USA.
- Department of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston, TX, USA.
| | - Jennifer Freytag
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, USA
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Thomas P Giordano
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bich N Dang
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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19
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Dandachi D, Dang BN, Lucari B, Teti M, Giordano TP. Exploring the Attitude of Patients with HIV About Using Telehealth for HIV Care. AIDS Patient Care STDS 2020; 34:166-172. [PMID: 32324481 DOI: 10.1089/apc.2019.0261] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Telehealth could address many of the factors identified as barriers for retention in HIV care. In this study, we explore people with HIV (PWH)'s attitudes about using telemedicine for HIV care instead of face-to-face clinic visits. We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February to June 2018. The survey items were used to assess PWH's attitudes toward and concerns for telehealth and explanatory variables; 371 participants completed the survey; median age was 51, 36% and were female, and 63% was African American. Overall 57% of respondents were more likely to use telehealth for their HIV care if available, as compared with one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits, including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long-standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Telehealth programs for PWH can improve retention in care. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri, USA
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Bich N. Dang
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Brandon Lucari
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle Teti
- Department of Public Health, University of Missouri, Columbia, Missouri, USA
| | - Thomas P. Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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