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IDWeek and EACS 2023
Leveraging Telemedicine for HIV Care: Research From IDWeek and EACS 2023

Released: November 28, 2023

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Key Takeaways
  • Physicians overwhelmingly support adoption of telemedicine, and patients are open to it but may have some reservations.
  • In sub-Saharan Africa, telemedicine has the potential to alleviate overcrowding in healthcare facilities and is being evaluated to deliver PrEP and PEP, particularly for patients who cannot access clinics or who may face stigma attending appointments in person.

Telemedicine has the potential to be an indispensable tool for HIV prevention and treatment, particularly for patients in underserved communities who would not otherwise have access to the healthcare system. Six studies from IDWeek and the 19th European AIDS Conference (EACS 2023) conducted in Uganda, Poland, and Argentina highlight the importance of telemedicine and explore some of the barriers to its widespread implementation.

Using Lemons to Make Lemonade: Virtual Visits for HIV Research During COVID-19 Lockdown in Uganda
The ACACIA study was a randomized, controlled trial of people living with HIV with asymptomatic cryptococcal antigenemia. Participants were randomized to either single dose liposomal amphotericin with fluconazole or fluconazole monotherapy. During the COVID-19 lockdown, follow-up visits were converted from in person to virtual. Data presented at EACS 2023 described outcomes of patients who had virtual follow-up. In total, 196 participants were contacted over 10 weeks, with 95% of study participants engaging in virtual visits. 27% of the participants had relocated to out-of-study catchment areas, 4.6% had previously missed in-person visits, and 81% reported preference for virtual visits.

Challenges to telemedicine included unstable network connections, schedule conflicts, difficulty reaching participants, and some participant preference for face-to-face interaction.

This report showed that conducting a research study virtually is possible, and could even improve follow-up, especially for participants who have difficulties visiting a research site in person.

Public Perception of Telemedicine: Poland
In Poland, Kowalska and colleagues conducted a survey-based study to investigate the opinion of people living with HIV on telemedicine in HIV care. The investigators surveyed 156 participants: 14% thought that telemedicine had a future, and 19% thought that it would have a future under certain conditions.

However, half of respondents had no opinion, and respondents who had a negative opinion were more likely to be from populations who would theoretically benefit the most from telemedicine, including people from rural areas with a lower level of education. The authors concluded that there is need for further modification of telemedicine practices and continued investigation of barriers to acceptance.

The Future of Telemedicine: Argentina
Four studies from Buenos Aires presented at IDWeek 2023 described obstacles and facilitators of telemedicine in HIV care. The data came from a research consortium of 4 HIV and infectious disease units of general acute public hospitals.

The first study, by Acosta and colleagues, assessed the association between sociodemographic and epidemiologic factors and the willingness of adults living with HIV to continue with telemedicine after COVID‑19.  Two thirds of over 2000 participants were willing to continue telemedicine after COVID‑19.

The second study, by Kierszenowicz and colleagues, aimed to analyze shifts in patient perception of factors that prevent or promote utilization of telemedicine. During the pandemic, patients responded that a key benefit of telemedicine was avoidance of exposure to COVID-19 and other viruses, and after the pandemic, they noted elimination of travel time to the hospital as the main advantage. 

The same author collected qualitative data on physicians’ perceptions of the challenges and benefits of telemedicine. All of the physician respondents stated that they would like to continue telemedicine in parallel to face-to-face consultation, and although internet connectivity was a challenge, they considered telemedicine a valuable tool for doctor and patient interactions. All professionals surveyed, including non-physicians, supported continuation of telemedicine.

Finally, the same investigators described their experience with using facilitators to support telemedicine in HIV care. The facilitators provided expertise, problem solving, and technical assistance in the delivery of telemedicine. They were able to recruit more than 4000 patients, and the authors concluded that telemedicine could be implemented affordably using facilitators. Put simply, having additional staff to support this intervention was found to be helpful. 

Application of Telemedicine in Sub-Saharan Africa
These studies provide critical guidance for implementation of telemedicine in my setting of sub-Saharan Africa. Here, we hope to implement telemedicine not just to make healthcare more accessible, but also to relieve overcrowded health facilities. 

Currently, we are piloting telemedicine for HIV pre-exposure prophylaxis (PrEP). Known as “e‑pharmacy”, we are working with an online pharmacy to deliver both PrEP and post-exposure prophylaxis (PEP) to clients. It has expanded our ability to reach patients, especially those who do not frequently attend health facilities. If an individual is at risk or exposed to HIV, a clinician conducts a virtual interview where they are screened for their risk. If they need PrEP or PEP, it is delivered through a courier with a health provider who also performs an HIV test.

However, we also face many of the challenges summarized in the studies above. Especially in sub‑Saharan Africa, telemedicine caters to people of a specific economic status who have access to either phone or internet service. Nevertheless, telemedicine still enables us to reach some of the demographic that is unable to physically visit a clinic. In addition, telemedicine helps people who need HIV prevention avoid stigma. In particular, we find that telemedicine has the potential to reach girls and young women who are at risk of HIV who may face stigma when visiting conventional facilities and men who in our settings visit health facilities less frequently compared to their female counterparts.

Altogether, these studies illustrate the usefulness and practicality of telemedicine in many different contexts. They show that, although adoption of telemedicine was a necessity during the pandemic, most patients and providers are interested in continuing with telemedicine. Based on the lessons learned from these studies, I foresee telemedicine playing a key role in sub-Saharan Africa in not just HIV prevention and treatment but also prevention and treatment of other diseases, especially for patients who are not able to attend conventional clinics.

Your Thoughts?
How have you implemented telemedicine in your practice? Do your patients prefer face-to-face visits, or are they satisfied with telemedicine for certain appointments?  Leave a comment to join the discussion.