Telehealth and Navigating HIV Care During COVID-19

People living with HIV are relying on telehealth to stay in care as we continue to battle COVID-19.
Signal’s Kathleen Van De Wille provides insight into how telehealth is transforming HIV care.

Telehealth has opened many possibilities for people during the pandemic. This is especially true for those with chronic conditions, who require regular doctor’s appointments to maintain their quality of life and health. This has been the case for people living with HIV. HIV is a virus that requires consistent medication to reach and maintain viral suppression. Once the virus is suppressed (so low in count it cannot be detected in tests) in someone’s body, that person cannot transmit it to others. As a result, it is vital that people who are living with HIV remain in consistent contact with a health care provider.
Ever since the inception of telehealth, HIV advocates, providers and policymakers have been trying to find a way to use telehealth to make it easier to receive care. Studies have shown that HIV patients receiving telehealth care have achieved positive health outcomes at the same rate as those receiving in-person care. People living with HIV often experience challenges receiving and staying in care even in the best of times, due to many factors including structural racism, stigma, lack of transportation, lack of housing, lack of health insurance, and a lack of sufficient health education.
There are challenges to using telehealth for individuals with HIV. Not all insurance carriers reimburse for telehealth, and some have specific limitations on who can access it or where they can access it. Medicaid and Medicare, for instance, usually limit reimbursement for telehealth visits to those located in rural areas but have waived that restriction during the pandemic. Telehealth also assumes that the patient will have access to a computer and internet, neither of which is guaranteed for individuals without stable housing or income. Telehealth can also be much more difficult for older individuals to access. However, with the rise of the COVID-19 pandemic, it became even more urgent for people living with HIV to have consistent access to their healthcare provider.
A December 2020 report, “Delivering HIV Care and Prevention in the COVID Era: A National Survey of Ryan White Providers,” by the Kaiser Family Foundation found that “Leveraging telehealth was one of the most common COVID-era changes made by providers, with virtually all (99%) saying they offer this service. Of those that did offer telehealth in the past, most (82%) reported expanding telehealth due to COVID-19.” They also found that “Forty-one percent (41%) of respondents [providers] report using telehealth more than 50% of the time and 6% report using it more than 90% of the time.”
The impact telehealth has had on linking people living with HIV to care and retaining them in care remains to be seen, as HIV data for 2020 and 2021 will not be available from the CDC for a few years. However, contemporaneous research suggests that telehealth has at least mitigated the number of people who would have dropped out of HIV care during the COVID-19 pandemic. In a time of challenge, crisis and struggle, we can be hopeful that that these results will inspire even more advancements in telehealth, increasing access and making it easier to get critical care in times of need.

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