Evaluation of the integration of telehealth into the same‐day antiretroviral therapy initiation service in Bangkok, Thailand in response to COVID‐19: a mixed‐method analysis of real‐world data

Abstract

IntroductionSame‐day antiretroviral therapy (SDART) initiation has been implemented at the Thai Red Cross Anonymous Clinic (TRCAC) in Bangkok, Thailand, since 2017. HIV‐positive, antiretroviral therapy (ART)‐naïve clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the first wave of the coronavirus disease 2019 (COVID‐19) outbreak in March 2020, telehealth follow‐up was established to comply with COVID‐19 preventive measures and allow service continuation. Here, we evaluate its implementation.MethodsPre‐COVID‐19 (until February 2020) clients who initiated SDART received a 2‐week ART supply and returned to the clinic for evaluation before being referred to long‐term ART maintenance facilities. If no adverse events (AEs) occurred, another 8‐week ART supply was provided while referral was arranged. During the first wave of COVID‐19 (March–May 2020), clients received a 4‐week ART supply and the option of conducting follow‐up consultation and physical examination via video call. Clients with severe AEs were required to return to TRCAC; those without received another 6‐week ART supply by courier to bridge transition to long‐term facilities. This adaptation continued post‐first wave (May–August 2020). Routine service data were analysed using data from March to August 2019 for the pre‐COVID‐19 period. Interviews and thematic analysis were conducted to understand experiences of clients and providers, and gain feedback for service improvement.ResultsOf 922, 183 and 321 eligible clients from the three periods, SDART reach [89.9%, 96.2% and 92.2% (p = 0.018)] and ART initiation rates [88.1%, 90.9% and 94.9% (p<0.001)] were high. ART uptake, time to ART initiation and rates of follow‐up completion improved over time. After the integration, 35.3% received the telehealth follow‐up. The rates of successful referral to a long‐term facility (91.8% vs. 95.3%, p = 0.535) and retention in care at months 3 (97.5% vs. 98.0%, p = 0.963) and 6 (94.1% vs. 98.4%, p = 0.148) were comparable for those receiving in‐person and telehealth follow‐up. Six clients and nine providers were interviewed; six themes on service experience and feedback were identified.ConclusionsTelehealth follow‐up with ART delivery for SDART clients is a feasible option to differentiate ART initiation services at TRCAC, which led to its incorporation into routine service.

Impact of Telehealth in HIV Ambulatory Clinic during COVID-19 Pandemic

“…Amatavete et al noted retention rates of 98% at 3 months and 98.4% at 6 months with the use of TELE during COVID in PLWH (15). Our study followed pts for a year and noted that after implementation of TELE during COV, more r new pts were accepted to the clinic (8.6% vs. 7%) and more pts had HIV VL suppression at the end of one year supporting the notion that TELE is an effective platform for the delivery of care and can supplement IN-P care.…”

Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Protocol for a Cluster Randomized Controlled Trial

“…A TH VOT app is also available on the Google Play store as an alternative platform that uses the system [ 15 ]. The patients and observers can easily register and use this VOT system through user authentication of the LINE (Line Corporation) app, which is the most commonly used app in Thailand [ 16 - 18 ]. With daily autonotification, both patients and observers will be notified about their appointment.…”

Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations

“…The allocation of support and resources will allow community stakeholders and trans-led organization to set research questions and agenda about gender-affirming PrEP systems and lead impactful research projects • Infuse lessons learned from COVID-19 telehealth programming for both hormones and PrEP services Drawing lessons learned from the COVID-19 response, telehealth has emerged as a critical programmatic tool to deliver and facilitate health services, especially among trans populations residing in areas where health care continues to be fragmented by geography (e.g., PrEP/gender affirming care deserts) and/or anti-trans health care policies [ 66 – 68 ]. Leveraging telehealth, including remote clinical visits, at-home lab collection services, and local or delivered pharmacy services, can increase access to gender-affirming PrEP programs for trans populations [ 54 , 69 ] Training and education • Develop health literacy and communication programs highlighting the efficacy of PrEP and hormones Given recent evidence showing continued efficacies of both PrEP and hormones when taken con-currently, we recommend developing and creating theory- and evidence-based education interventions and/or health literacy programs with curriculum materials and health communication strategies focused on concerns and misinformation about PrEP and hormones among providers and transgender and nonbinary patients to help manage decisions about care. Rather than stigmatizing risk behaviors of transgender people, utilize gain-framed counseling approach to encourage clients to focus on protection and healthy behaviors to increase PrEP and gender affirming care uptake [ 70 ] • Train providers on PrEP and high-quality gender-affirming care Providers working within a gender-affirming PrEP system must be competent in both PrEP and high-quality gender affirming care.…”