How Telehealth Is Expanding Access To HIV Testing and PrEP Treatment
Telehealth plays large role in goal to reduce 90% of HIV infections by 2030
Since 1981, HIV/AIDS has infected over 85 million people worldwide, making it one of the world's most serious health challenges. However, thanks to better education, treatment and testing, the U.S. has decreased annual infection rates by greater than two-thirds. Interventions, like telehealth, have played a significant role in helping to expand access to HIV care, like HIV PrEP, especially since the COVID-19 pandemic.
Below, we’ll explore how telehealth has been utilized to support HIV prevention and care management.
Telehealth and HIV: The four EHE pillars
In 2019, the operational plan, Ending the HIV Epidemic in the U.S. (aka EHE), was launched to help achieve a 90% reduction of new HIV infections in America by 2030. Telehealth is a major component of the plan, as it removes several access-to-care barriers that certain populations and geographic areas experience.
The EHE plan has four pillars of action to help them achieve this goal: DIAGNOSE, TREAT, PREVENT, and RESPOND. Telehealth is being implemented in multiple ways in each of these strategic pillars.
Telehealth and DIAGNOSE
This pillar aims to diagnose all individuals with HIV as early as possible. Currently, 1 in 5 people have HIV but don’t know they're infected. Telehealth interventions, like ordering a self-test during a video visit, may help capture this audience.
In 2021, researchers completed a systematic study that evaluated the acceptability, feasibility and efficacy of telehealth interventions for this population. Although limited primary studies were available, they still determined that videoconferencing and video-based interventions are effective means of increasing HIV testing.
Taking an at-home HIV test reduces stigma and alleviates the need to navigate the complex healthcare system. Patients with technology at home can connect directly with a provider and review their diagnostic lab results. Patients without technology access can utilize the hub-and-spoke model, which may involve visiting one site to conduct a telehealth visit with a provider at another location.
Telehealth and TREAT
The goal of this pillar is to link those diagnosed with HIV to the care and navigation services they need. Linkage to care is vital, as it can lessen the time to viral suppression, which prevents transmission of the illness via sexual intercourse.
With telehealth, patients can access virtual appointments with HIV specialists, receive medication support and ongoing counseling. This is timely, as there is an emerging shortage of HIV providers, given that many look to retire in the next ten years.
The 2021 systematic study found that video-based interventions effectively increased HIV treatment initiation and medication compliance.
In 2023, another study looked specifically at the effect telehealth had on Antiretroviral therapy among patients living with HIV. The results confirmed that telehealth improved treatment adherence, enhanced patient quality of life, and may strengthen the capacity of HIV care services.
Telementoring for providers has also shown promise. Live video conference sessions with multidisciplinary specialists can help providers learn how to manage complex cases and tailor treatment plans for high-risk groups. Patients with HIV tend to have improved clinical outcomes if their clinician has HIV experience and training via telementoring.
Telehealth and PREVENT
The third pillar, PREVENT, is designed to stop new HIV transmissions by using proven interventions. Today, one of the best ways to prevent HIV is via the medication PrEP (pre-exposure prophylaxis).
According to the CDC, PrEP alleviates the risk of developing HIV from intercourse by almost 99% and injection drug use by nearly 74%. It does this by stopping HIV enzymes from replicating in the body, but it must be used as instructed for it to be effective.
Telehealth solutions, like virtual appointments with a prescriber, improve access and also help individuals get answers to questions like “Where to get HIV prep?”
A 2023 study done in Brazil demonstrated that telehealth for PrEP delivery could help rationalize services so those with a higher risk of HIV could receive in-person care. In addition, it increased PrEP persistence and reduced medication interruptions. Even with participants having to pick PrEP up from a pharmacy in this study, the linkage to care proved beneficial.
It’s also possible to get an online PrEP prescription delivered via mail. In Mississippi, for example, access to medication is primarily limited to urban areas. One study found that individuals in the more rural regions were comfortable and accepting of PrEP via mail delivery. Researchers also noted that expanding remote options encourages prescription initiation while reducing healthcare costs.
Telehealth and RESPOND
The final pillar is dedicated to rapidly reacting to potential HIV outbreaks so that individuals can access prevention and treatment services. This might look like scaling up care and prevention methods, which telehealth tools excel at. Some of the current interventions include:
Video conferencing
Phone calls
Text messages: automated reminders and case manager exchanges may increase viral suppression.
Telementoring platforms for providers
Virtual peer support groups
Using telehealth for HIV care
As you can see, telehealth plays an instrumental role in HIV care. It alleviates challenges with transportation, availability and stigma. These interventions inevitably lead to regular appointment attendance, slowed disease progression and better health outcomes.
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