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Telehealth availability improves HIV care in VA networks
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The availability of telehealth programs improved viral suppression in patients with HIV in three Veterans Affairs health care networks, according to recently published study findings.
“In the United States, health care for people with HIV infection has historically been concentrated in HIV specialty clinics in large urban areas. This specialized and centralized delivery system promotes high-quality care for patients with a complex and stigmatized condition, but also creates poor geographic access to care for patients in outlying suburban and rural areas far from specialty clinics,” Michael E. Ohl, MD, MSPH, an investigator in the Center for Access and Delivery Research and Evaluation at the VA Medical Center in Iowa City and associate professor of infectious diseases at the University of Iowa Carver College of Medicine, and colleagues wrote.
“Telehealth programs have potential to improve access to HIV specialty care in outlying areas, which could in turn improve retention in care and treatment outcomes. Available evidence indicates that telehealth programs deliver high-quality HIV care, but prior studies were small, suffered from selection bias, or lacked control groups.”
To determine the impact of telehealth on documented viral suppression in patients with HIV, Ohl and colleagues conducted a cluster-randomized evaluation between 2015 and 2016, offering telehealth visits to patients who previously traveled to HIV specialty clinics. According to the study, patients were randomly assigned to immediate telehealth availability (n = 925) or availability 1 year later (n = 745), which represented the control group.
Overall, 120 patients used telehealth when it was available, according to Ohl and colleagues. Study findings showed that the availability of telehealth programs led to small improvements in viral suppression in the intention-to-treat analyses, with 78.3% of patients virally suppressed compared with 74.1% of patients in the control group (RR = 1.06; 95% CI, 1.01-1.11).
A complier average causal effects analyses, which “compared outcomes for telehealth users to outcomes for control patients with equal propensity to use telehealth, were it available,” showed large improvements in viral suppression among telehealth users, 91.5% vs. 80% (RR = 1.14; 95% CI, 1.01-1.30).
“Use of telehealth programs was low overall but increased with increasing travel time saved. The availability of telehealth programs was associated with small population-level improvements in documented viral suppression among all patients in service areas of telehealth clinics, and large improvements among program users,” the authors concluded. “HIV clinics should offer telehealth visits for patients facing travel burdens.” – by Caitlyn Stulpin
Disclosure: Ohl reports being the principal investigator for an investigator-sponsored research grant from Gilead Sciences to the University of Iowa to conduct research unrelated to the manuscript.
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