Technology, Privacy Concerns Pose Barriers to Virtual HIV Care

During the COVID-19 pandemic, patients living with HIV were satisfied overall with telehealth appointments, but they identified challenges to virtual care, such as technology limitations and privacy concerns, a study published in AIDS and Behavior found.

Health systems have previously used telehealth for HIV care to help reduce travel burden for patients, increase access to timely care, and alleviate stigma.

Researchers from Yale University and SUNY Downstate Health Sciences University conducted a study at two urban HIV clinics in New Haven, Connecticut, and Brooklyn, New York, to understand patient and clinician perceptions of telehealth. They used a survey to glean patient feedback and organized virtual focus groups for provider feedback.

There were 273 patients who had an in-person or telehealth visit at the clinics between May 15, 2020, and Aug. 11, 2020, and responded to the follow-up survey. Out of those patients, 205 had a telehealth visit in the two months before the survey.

The majority of the patients who used telehealth had an audio-only visit (85 percent), while 7.3 percent had a video visit. Most of the visits were with the patient’s HIV provider, but some patients used telehealth to see a specialist, behavioral health provider, nurse, pharmacist, or nutritionist.

Patients had a generally positive view on telehealth, researchers found. Nearly 75 percent of participants said that their telehealth visit was just as good or better than a traditional in-person visit, and 67 percent said that they would probably or definitely recommend telehealth to someone else.

Just over 40 percent of telehealth users reported that they thought the virtual visits were useful during the pandemic. Patients were more likely to share this sentiment if they had not recently received healthcare services. Smartphone availability also impacted patients’ thoughts on telehealth, as patients who did not own a smartphone were less likely to say that telehealth was useful, compared to patients with a smartphone.

More than 25 percent of all study participants, including those who did not have a telehealth visit, reported that telehealth visits would be useful after the pandemic ends.

Patients and clinicians agreed that telehealth was a good resource to maintain continuity of care during the pandemic. Clinicians reported that virtual care helped them connect with patients and address patients’ isolation and fears that accompanied the pandemic. In addition, clinicians were able to teach patients skills, such as self-administration of injectable medications, to avoid treatment interruptions. Providers also noted that telehealth allowed for more patient-centered care. 

Patients perceived the telehealth visits as convenient, reporting that virtual care helped reduce the burden of needing to travel and did not significantly disrupt their daily routines, the study showed.

However, patients and providers indicated challenges they faced while navigating virtual care as well.

Clinical staff reported that audio-only visits made it hard to perceive patients’ emotions, as they could not observe non-verbal cues. Providers also perceived that telehealth increased their workload.

A common barrier to telehealth for all participants was technology. A lack of access to technology devices and low digital literacy levels were perceived as barriers for patients and providers. Inconsistent use of videoconferencing platforms was also a challenge for clinical staff when they were first launching a telehealth program. Further, connection issues during virtual visits posed a challenge and disrupted appointments for some patients.

Privacy was a concern for a handful of telehealth patients and clinicians as well. Participants struggled to find spaces in their home that would ensure confidentiality during the visits, and some patients found it difficult to discuss their personal information virtually. However, providers reported that telehealth made it easier to engage patients’ family members and care team if it was the right option for the patient.

While patients and providers had positive overall experiences with using telehealth for HIV care, they acknowledged the need for improvements.

“Efforts to optimize telemedicine implementation for HIV care should consider strategies to improve technology support for PWH (patients with HIV), patient-centered care options to maintain care, innovative platforms to allow remote monitoring, and establishing and implementing appropriate funding, billing and reimbursement methods to enable universal availability,” the researchers concluded.