Department of Veteran Affairs clinics that offered HIV patients telehealth programs found modest improvements in population-level viral suppression despite a low utilization rate of roughly one in eight patients, according to a study published last month in Open Forum Infectious Diseases.
“Our findings describe the impact of HIV telehealth programs implemented as quality improvement programs in real-world settings, and are most relevant to other urban HIV clinics that serve patients who travel long distances to clinic from outlying suburban and rural areas,” the researchers wrote.
Among 925 patients offered a telehealth intervention at their primary clinics (intention to treat [ITT] group), 13% elected to use the service within a one-year study period. This group had a median of two telehealth visits, and more total HIV clinic visits than those who were randomized to the control group (n = 745).
When comparing the full cohorts, concentrations of HIV were kept within suppression range among 78.3% of veterans in the ITT group, as opposed to 74.1% of controls (95% confidence interval of absolute difference, 0.1%-8.4%). A secondary analysis comparing the outcomes of telehealth users to controls who were equally likely to use the telehealth service also found a significant improvement in documented viral suppression related to telehealth use (91.5% versus 80%; 95% confidence interval of absolute difference, 0.1%-21.6%).
HOW IT WAS DONE
Beginning in 2015, researchers recruited participants from three VA health networks that included a centrally-located HIV clinic and several affiliated primary care clinics located anywhere from 14 to 114 miles from the HIV clinic. Patients who had previously traveled to an HIV specialty clinic were randomly assigned to the ITT group, which offered the option of a telehelath visit conducted at the patient’s local primary care clinic, or the control group, which was offered the same option after one year.
Over the course of this year-long study period, researchers monitored the rate of telehelath utilization among ITT group members as well as achievement of viral suppression among both cohorts. The researchers coded for viral suppression if a viral load was measured within the year and the final viral load was fewer than 200 copies per ml. Along with the primary analysis, a complier average causal effect (CACE) analysis was conducted to estimate the direct impact of the program on similar participants across the groups.
WHAT’S THE HISTORY
The VA has been among the first systems and public entities to explore how telehealth could improve its services. Last year’s American Telemedicine Association conference featured testimonials from experts who outlined the benefits of in-home psychotherapy for veterans, while a study published shortly after showed a chronic liver disease mortality benefit associated with a VA-run telemedicine consultation program. Around the same time, the department finalized a federal rule that allows providers to deliver care to facilities across state lines.
“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. HIV clinics should offer telehealth visits for patients facing travel burdens,” the researchers concluded.