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Telemedicine improved viral suppression in inmates with HIV
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Inmates with HIV had greater viral suppression and improved CD4 counts when they received care from subspecialists via telemedicine, according to data published in Clinical Infectious Diseases.
“While our study was in the prison system, there is no reason to believe this technology cannot be used in the community,” Jeremy Young MD, MPH, assistant professor of medicine at the University of Illinois at Chicago, told Infectious Disease News. “There are people living with HIV in rural areas, nursing homes and other environments with barriers to access and we should explore the use of telemedicine technology to remove these barriers.”
Jeremy Young
Young and colleagues compared two cohorts of patients. The first was the pre-telemedicine cohort, which included patients managed by on-site physicians at the correctional center. The second was the telemedicine cohort, which included patients who were managed by a multidisciplinary team via telemedicine clinics. The primary outcome was virologic suppression for both.
The pre-telemedicine cohort included 514 individuals with data available from July 2009 to June 2010. In the telemedicine cohort, there were 686 individuals who received clinic care from July 2010 to June 2012. There were no differences in CD4 count between the groups at baseline.
The telemedicine group had significantly more patients achieve viral suppression: 91.1% vs. 59.3% for the pre-telemedicine group (OR=7; 95% CI, 5.1-9.8). This persisted when the analysis excluded patients who were virally suppressed at the first visit and controlled for the total number of clinic visits. They also had greater virologic suppression regardless of baseline CD4 count.
Patients in the telemedicine group also had a lower mean community HIV viral load during the first six visits: 89.5 copies/mL vs. 206 copies/mL. They also had a lower mean in-care HIV viral load at the final visit: 19.2 copies/mL vs. 107.4 copies/mL.
Lastly, the overall CD4 count was significantly higher in the telemedicine group: 527 cells/mm3 vs. 491.6 cells/mm3.
“Many inmates with HIV could benefit from subspecialty care, but the onsite physicians are, for the most part, generalists that do not have the expertise to provide complex HIV care,” Young said. “As subspecialists with a multidisciplinary clinic, including an HIV-trained physician and pharmacist, we can use telemedicine to see patients quickly and easily. Providing onsite subspecialist care is not practical, and with telemedicine, we can completely remove geographic barriers.”
Young said that there are limited data regarding the use of telemedicine in other fields, such as psychiatric care, certain surgical services and ED triage, but most programs do not have outcomes data. He also suggested that for the prison population, telemedicine may have a similar benefit for patients with hepatitis C, especially with the rapidly evolving guidelines for HCV treatment.
“I believe telemedicine can be used for multiple acute and chronic diseases,” Young said. “Any patient with a disease who may benefit from the involvement of a specialist providing up-to-date, evidence-based care could benefit from improved access via telemedicine.” — by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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