Abstract Background Federally qualified health centers (FQHCs) in the United States began the widespread use of telemedicine for HIV care during the COVID-19 pandemic. During a mature phase of the pandemic, we sought to increase the uptake of telemedicine, characterize uptake by modality (telephone versus video), and explore the association of telemedicine use with viral suppression. Methods We implemented a multi-pronged intervention to increase telemedicine (particularly with video) and performed a prospective cohort study to evaluate this intervention. The intervention included: (1) provision of an easy-to-use video visit platform; (2) training on telemedicine best practices; (3) computer-based and support staff reminders to offer a choice of telephone or video telemedicine; (4) a telemedicine navigator; and (5) quarterly quality improvement meetings. We conducted baseline and endline surveys and chart reviews with a cohort of people living with HIV (PLHIV) to measure telemedicine use (including offer, uptake, and visit completion by modality) and changes in viral load. We used mixed effects regression models to evaluate the intervention’s association with viral suppression over time (< 40 copies/mL). Results We enrolled 271 PLHIV between March and November 2022 and implemented the intervention from August 2022-October 2023. Telemedicine visits (telephone and video) in this cohort increased during the intervention period from 13% to 17% of all visits, with this increase predominantly driven by telephone visits. Clinicians’ offer of telemedicine visits (based on participant report) varied, with 36% of clients offered both telephone and video visits during the intervention period, 36% offered telephone visits only, and 28% not offered any telemedicine. Visit completion was highest for telephone visits (82%) and lower for video (58%) and in-person (57%) visits. Viral suppression rates were not significantly different from baseline to endline, regardless of telemedicine use: 71.0% to 77.5% in non-users ( p = 0.26) and 83.8% to 81.0% ( p = 0.19) in users. Conclusions Our intervention increased the use of telemedicine, predominantly delivered as telephone visits. Additional research is needed on the impact of telemedicine on care engagement over time, on viral suppression over longer follow-up, and on strategies to increase utilization of video visits for PLHIV cared for in FQHC settings.
Hoffman et al. (Thu,) studied this question.