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Patient Experiences with Telemedicine for HIV Care During the First COVID-19 Wave in Atlanta, Georgia
Karla I Galaviz1, N Sarita Shah2,3, Mariana Gutierrez3
1Indiana University School of Public Health, Bloomington, Indiana, USA.
Insights
Persons with HIV (PWH) reported high satisfaction with telemedicine during COVID-19. However, concerns about physical examination and data privacy were noted, especially among women, indicating areas for improvement in future HIV care models.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- The COVID-19 pandemic necessitated rapid adoption of telemedicine for continuity of care.
- Understanding patient experiences with telemedicine is crucial for optimizing healthcare delivery, particularly for vulnerable populations like persons with HIV (PWH).
- Previous research has not fully explored PWH's perspectives on telephone-based telemedicine during the initial phase of the pandemic.
Purpose of the Study:
- To investigate the experiences of persons with HIV (PWH) with telemedicine services during the first wave of the COVID-19 pandemic.
- To assess the usefulness, quality, and satisfaction with telephone-based telemedicine among PWH.
- To identify specific concerns and demographic differences in telemedicine experiences among PWH.
Main Methods:
- A convenience sample of adults with HIV (PWH) receiving care at an urban clinic in Atlanta participated.
- Patients completed a structured survey assessing telemedicine usefulness, quality, satisfaction, and concerns during March-May 2020.
- Demographic data, HIV-1 RNA, and CD4+ T cell counts were abstracted from medical charts; bootstrapped t-tests and chi-square tests analyzed differences.
Main Results:
- 101 PWH completed the survey; most were virally suppressed with high CD4 counts.
- High ratings for telemedicine quality (median 6.5/7), usefulness (median 6.0/7), and satisfaction (median 6.3/7) were reported.
- Key concerns included provider examination limitations (28%) and lack of lab tests (28%); women reported higher concerns regarding examination (92% vs. 50%) and data privacy (69% vs. 23%) compared to men.
Conclusions:
- Persons with HIV (PWH) generally expressed high satisfaction with telephone-based telemedicine during the COVID-19 pandemic.
- Significant concerns regarding the ability of providers to conduct physical examinations and ensure data privacy were identified, particularly among women.
- Future HIV telemedicine models should incorporate strategies to address these specific concerns to enhance patient care and trust.
Abstract:
We explored experiences with telemedicine among persons with HIV (PWH) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A convenience sample of adults (>18 years) receiving care in an urban clinic in Atlanta were invited to participate. Patients completed a structured survey that assessed the usefulness, quality, satisfaction, and concerns with telemedicine services (telephone calls) received during the first wave of the COVID-19 pandemic (March-May 2020). Demographic, plasma HIV-1 RNA, and CD4+ T cell count data were obtained through medical chart abstraction. Bootstrapped t-tests and chi-square tests were used to examine differences in patient experiences by age, sex, and race. Of 406 PWH contacted, 101 completed the survey (median age 55 years, 84% men, 77% Black, 98% virally suppressed, median CD4 count 572 cells/μL). The main HIV care disruptions experienced were delays in follow-up visits (40%), difficulty getting viral load measured (35%), and difficulty accessing antiretroviral therapy (21%). Participant ratings for quality (median score 6.5/7), usefulness (median score 6.0/7), and satisfaction (median score 6.3/7) with telemedicine were high. However, 28% of patients expressed concerns about providers' ability to examine them and about the lack of laboratory tests. More women had concerns about providers' ability to examine them (92% vs. 50%, p = .005) and about the safety of their personal information (69% vs. 23%, p = .002) compared with men. No age or race differences were observed. Although PWH are generally satisfied with telephone-based telemedicine, concerns with its use were notable, particularly among women. Future HIV telemedicine models should address these.
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