In a recent study published in AIDS and Behavior, researchers assessed how measures of retention in human immunodeficiency virus (HIV) care have changed due to the coronavirus disease 2019 (COVID-19) pandemic.
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in one of the most serious public health crises in recent years. The COVID-19 pandemic changed human interactions worldwide 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 vaccinations and anti-viral therapies developed in the last two years, studies are now beginning to examine the impact of COVID-19 on other healthcare measures.
Acquired immunodeficiency syndrome (AIDS) care requires retention to ensure the individual health of HIV patients and prevent HIV transmission in the community.
Retention, which includes monitoring viral loads and CD4+ cell counts and maintaining antiretroviral therapy, generally occurs at HIV care clinics and is measured by the gap between sequential HIV care clinic visits or the number of missed visits in a year.
During the COVID-19 pandemic, the HIV care clinics in the United States (U.S.) had to cancel in-person retention visits and incorporate telehealth appointments to provide continued care to persons with HIV (PWH). However, the impact of these changes on HIV retention measures remains to be explored.
About the study
The present study assessed the retention measures during the pre-pandemic years and year one of the COVID-19 pandemic, at a medical care clinic in Chicago, Illinois, and explored how the inclusion of telehealth appointments affected these measures.
The researchers collected data for PWH 18 years old or above who received HIV care between March 15, 2018, and March 14, 2021, at the HIV care clinic. The HIV care clinics had canceled in-person appointments beginning 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. Including participants was based on at least one appointment between March 15, 2018, and March 15, 2020.
Data on demographic factors, comorbidities, in-person, and telehealth HIV care appointments, and the outcomes of these appointments were collected from the participants. Six HIV care retention measures were calculated. These included three missed visit measures and three kept visit measures. 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.
The results indicated that there was a reduction in the retention of patients during the COVID-19 pandemic, but the demographic characteristics of the retained patients remained similar across both study periods. The kept visit retention measures indicated that PWH were more likely to be retained in the pre-pandemic phase than during the COVID-19 pandemic.
The Health and Resources Services Administration HIV/AIDS Bureau (HRSA HAB) measure, which consists of two kept visits with a gap of 90 days or more during the one-year observation period, indicated a 72% retention pre-pandemic and a 51.2% retention during the pandemic.
The authors noted that other studies found missed HIV care visits to be associated with concerns over food security, housing, mental health, and substance use during the pandemic.
Notably, when telehealth appointments were included in the analyses, more PWH were considered retained during the pandemic according to all three kept visit measures. This indicated that telehealth facilities improved access to HIV care during the COVID-19 pandemic.
While telehealth appointments are limited by the inability to measure vitals or perform laboratory tests, PWH reported an improved ability to discuss treatment and prescription refill needs with their care providers.
Interestingly, the Spearman coefficients calculated in the study indicate a higher correlation among kept visit measures during the pandemic compared to the pre-pandemic period, with and without the inclusion of telehealth appointments. The authors believe this provided reassurance that traditional retention measures continued to be effective during the COVID-19 pandemic.
To summarize, the study examined the impact of the COVID-19 pandemic and the inclusion of telehealth appointments in HIV medical care facilities in the U.S. on the retention of HIV care by PWH. The results indicated a decrease in retention with the onset of the pandemic, which is partly explained by the cancellation of in-person appointments by the care clinics.
The inclusion of telehealth appointments resulted in a larger number of retentions. Despite the testing limitations of 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.