Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare

Abstract

Background: In response to the COVID-19 pandemic, we scaled up telemedicine and rideshare services for clinic and laboratory visits for pediatric and adolescent patients with HIV. Setting: HIV subspecialty program for patients aged 0–24 years at Children's National Hospital, Washington, DC. Methods: Using the χ 2 and Wilcoxon rank sum tests, we compared demographics, visit and laboratory data, and rideshare usage among patients who scheduled telemedicine at least once (telemedicine) versus those who never scheduled telemedicine (no-telemedicine) during the pandemic (April–September 2020). We compared the number and proportion of scheduled and completed clinic visits before the pandemic (April–September 2019) with those during the pandemic. Results: We analyzed 178 pediatric and adolescent patients with HIV (median age 17.9 years, 89.3% Black, 48.9% male patients, 78.7% perinatally infected), of whom 70.2% and 28.6% used telemedicine and rideshare, respectively. Telemedicine patients scheduled more visits (236 vs 179, P < 0.0001) and completed a similar proportion of visits (81.8% vs 86.0%, P = 0.3805) compared with no-telemedicine patients. Laboratory testing rates (81.3% versus 98.5%, P = 0.0005) were lower in telemedicine patients compared with no-telemedicine patients. Rideshare usage (12.4% versus 26.5%, P = 0.0068) was lower in telemedicine versus no-telemedicine patients. During the pandemic, most of the patients (81.0%) had HIV RNA <200 copies/mL. The total number of completed visits and the proportion of visits completed were similar before and during the pandemic. Conclusion: Most of the pediatric and adolescent patients with HIV used telemedicine and maintained HIV RNA <200 copies/mL during the pandemic. Despite rideshare usage, laboratory testing rates were lower with telemedicine compared with in-person visits.

Projecting the Clinical and Economic Impacts of Changes to HIV Care Among Adolescents and Young Adults in the United States: Lessons From the COVID-19 Pandemic

“…In both modeled cohorts, when YHIV experienced improved adherence to ART in the Telehealth scenario analyses, long-term outcomes improved relative to in-person care. This is consistent with previous studies of short-term adherence interventions [ 42 ], and is indicative of the potential short- and long-term benefits of telehealth for certain populations, including youth [ 40 , 45 ]. Offering choice and hybrid approaches may be optimal for patients; while telehealth is ideal for some youth, for other YHIV who already struggle with engagement in care, a mandated switch to telehealth may make them feel deprioritized.…”

“…If telehealth improves retention by even a small amount compared with in-person care, it leads to similar health outcomes; if laboratory testing could be obtained, then telehealth may lead to better health outcomes than clinic care. A youth HIV clinic in Washington, DC that offered telehealth alongside rideshare services so that youth could complete laboratory testing offers a promising model for this care modality [ 45 ]. If telehealth is not reimbursed equally to in-person visits, telehealth use may exacerbate existing health inequities; ensuring equitable access to a wide variety of care modalities should remain a priority for policymakers [ 9 , 43 ].…”

“…This analysis has several limitations. First, while telehealth scale-up and outcomes following the implementation of lockdown measures have been described, clinic experiences and outcomes varied widely, and follow-up time is short to date [ 1 , 2 , 7–9 , 40 , 43 , 45 , 48 ]. Additionally, we had insufficient data to inform differences in the full panel of laboratory-based testing (such as testing for sexual transmitted infections, complete blood counts, and liver function tests) associated with in-person compared with telehealth visits and thus only modeled specific differences in routine CD4 and viral load tests between the clinical scenarios.…”

HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges

“…In addition, caregivers and family members who cannot accompany patients to in-person visits can attend virtually. Another advantage is that providers have the flexibility to offer patients an alternative to in-person visits if patients do not require lab work, rather than canceling or having them not show up [ 22 ].…”

Exploration of a Mobile Technology Vulnerability Scale’s association with antiretroviral adherence among young adults living with HIV in the United States

“…The Pew Research Center shows high access to mobile phones among youth and young adults (9), as a result, many studies are examining the influence of mobile phone interventions for setting reminders to take and refill medications, receiving psychotherapeutic interventions, and communicating with healthcare teams (11)(12)(13). Additionally, the SARS-CoV-2 pandemic has further underscored the importance of access to digital technologies, many of which have allowed for remote clinical visits with HIV care providers and mental health and substance use counseling, while maintaining a human connection (14)(15)(16)(17). However, many questions remain, including: What does mobile phone access look like among YLWH?…”