In a recent study published in AIDS and Behavior, researchers assessed how retention measures in human immunodeficiency virus (HIV) care have changed due to the coronavirus disease 2019 (COVID-19) pandemic. .
Study: Measuring retention in HIV care during the first year of the COVID-19 pandemic: the impact of telehealth. Image credit: elenabsl/Shutterstock
background
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused one of the most serious public health crises in recent years. The COVID-19 pandemic changed human interactions around the world due to the need for social distancing to limit the spread of the virus.
With the threat of severe COVID-19 now under control, courtesy of the various vaccines and antiviral therapies developed in the past two years, studies are now beginning to examine the impact of COVID-19 on other health measures.
Acquired immunodeficiency syndrome (AIDS) care requires containment to ensure the individual health of HIV patients and to prevent HIV transmission in the community.
Retention, which includes monitoring of viral loads and CD4+ cell counts and maintenance of antiretroviral therapy, usually occurs in HIV care clinics and is measured by the gap between sequential visits to the HIV clinic or the number of missed visits in a year.
During the COVID-19 pandemic, HIV care clinics in the United States (US) had to cancel face-to-face retention visits and incorporate telehealth appointments to provide continuity of care for people living with HIV (PWH) . However, the impact of these changes on HIV retention measures remains to be explored.
About the study
The present study evaluated retention measures during the years before the pandemic and the first year of the COVID-19 pandemic, in a health care clinic in Chicago, Illinois, and explored how the inclusion of telehealth appointments affect these measures.
Researchers collected data from PWH aged 18 years and older who received HIV care between March 15, 2018 and March 14, 2021 at the HIV care clinic. HIV care clinics had canceled face-to-face appointments as of March 15, 2020.
Therefore, the study period was divided into the pre-pandemic phase from March 15, 2019 to March 14, 2020, and March 15, 2020, and March 14, 2021, which was considered the first year of the pandemic period Inclusion of participants was based on at least one appointment between March 15, 2018 and March 15, 2020.
Data were collected on demographic factors, comorbidities, face-to-face and telehealth appointments for HIV care, and the outcomes of these participants’ appointments. Six measures of HIV care retention were calculated. These included three measures of missed visits and three measures of maintained visits. These measures were calculated separately for the pre-pandemic and pandemic periods and were further divided based on the inclusion or exclusion of telehealth appointments.
results
The results indicated that there was a reduction in patient retention during the COVID-19 pandemic, but the demographic characteristics of the retained patients remained similar during the two study periods. Measures of retained visit retention indicated that PWH were more likely to be retained in the pre-pandemic phase than during the COVID-19 pandemic.
The Health and Human Services Administration Office of HIV/AIDS (HRSA HAB) measure, which consists of two visits held 90 days or more apart during the one-year observation period, indicated 72% retention before the pandemic and 51.2% retention during the pandemic.
The authors noted that other studies found that missed HIV care visits were associated with concerns about food security, housing, mental health, and substance use during the pandemic.
In particular, when telehealth appointments were included in the analyses, more PWH were considered to be kept during the pandemic according to all three measures of kept visits. This indicated that telehealth facilities improved access to HIV care during the COVID-19 pandemic.
Although telehealth appointments are limited by the inability to measure vital signs or perform laboratory tests, PWH reported an improved ability to discuss treatment needs and prescription refills with their care providers.
Interestingly, the Spearman coefficients calculated in the study indicate a higher correlation between measures of visits maintained during the pandemic compared to the pre-pandemic period, with and without the inclusion of telehealth appointments. The authors believe this ensured that traditional containment measures remained effective during the COVID-19 pandemic.
conclusion
In summary, the study examined the impact of the COVID-19 pandemic and the inclusion of telehealth appointments in HIV health care facilities in the US on HIV care retention by PWH. The results indicated a decrease in retention with the onset of the pandemic, which is explained in part by the cancellation of face-to-face appointments by care clinics.
The inclusion of telehealth appointments resulted in greater retention. Despite the limitations of testing telehealth methods, participants reported that the ability to communicate with their HIV care provider during the pandemic was helpful.
The findings highlight the need to include telehealth in HIV care retention measures.