Pediatric, Adolescent Patients Desire Continued Telehealth Use in HIV Care

Most children and youth receiving HIV care at a specialty clinic reported being interested in telehealth services for HIV care, according to a study published in AIDS and Behavior. Overcoming barriers for telehealth use could improve outcomes in children and youth living with HIV (YLHIV) in the United States, according to the study authors.

Telehealth use increased in both primary and specialty care during the COVID-19 pandemic to replace in-person visits, with specialty clinics for HIV reporting an increase in video and phone visits during the pandemic and a decline in these visits after it become safer to attend in-person visits. Telehealth has been found to be a suitable replacement for in-person visits in YLHIV across the United States, the authors noted.

YLHIV have lower rates of viral suppression, attending appointments for HIV care, and maintaining medication adherence. This study aimed to assess the knowledge of telehealth and interest in future telehealth in YLHIV, both for HIV care and mental health care.

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YLHIV who received treatment at the Children’s National Hospital HIV Prevention and Treatment Services (HPTS) Program in Washington D.C. were surveyed. HIV medical management through telehealth was first offered in March 2020 at HPTS, and a psychologist would determine the services that the patient needed, including counseling and targeted interventions for HIV diagnosis disclosure and coping with the diagnosis.

Patients up to 24 years of age were given an anonymous 5-item survey between September 2020 and February 2021 if they were receiving care at HPTS. The medical provider or case manager gave patients the survey during an in-person visit, and a caregiver completed the survey for children aged 12 years and younger. Access to technology, knowledge of telehealth, assistance required to use the Zoom platform, interest in telehealth, and any reasons for not wanting more telehealth were all topics covered in the survey. A similar survey for children aged 12 to 24 years was given for telehealth for mental health. The survey was only given in English.

There were 103 children and YLHIV included in the study. The median age was 17.6 years, 88.3% of patients were non-Hispanic Black, and 52.4% were female; 80.6% had public insurance. A majority of the participants had used telehealth by the end of the survey period (70.9%) and nearly three-quarters had heard of telehealth (74.9%). Nearly the entire population reported having access to internet and an electronic device (98.1%) and most had interest in using telehealth (87.4%); the 2 respondents who did not have internet access also reported interest in telehealth. Some participants reported needing help to install Zoom for future telehealth use (9%).

Those who did not express interest in telehealth cited privacy concerns, discomfort with virtual interactions, and not trusting the method of communication as well as preference for in-person, not having a computer, and needing language interpretation.

There were 21 YLHIV who used mental health services and were surveyed about their experiences—51% were female and 78% were non-Hispanic Black. Most used individual sessions (67%) whereas some attended group sessions (9%) or both individual and group sessions (24%). The majority of the participants found scheduling virtual services easy (81%) or very easy (14%), with the same percentage being very satisfied and somewhat satisfied with their mental health session respectively; 81% said that they would recommend the services to others.

There were some limitations to this study. It included a small sample size from a singular center and was only conducted in English, which excluded Spanish speaking patients. The results may have limited generalizability to the rest of the United States. Facilitators of telehealth use could not be looked into due to short length. Telehealth preferences could not be linked to HIV outcomes due to the anonymous nature of the survey.

Continued telehealth use is desirable among children and YLHIV who receive care at HPTS in Washington D.C., the authors concluded. Optimizing telehealth use and overcoming barriers to these services may help improve health comes in children and YLHIV in the United States.

Reference

Koay WLA, Aware Y, Andine T, et al. Patient perspectives on telehealth for HIV and mental health care at a pediatric and adolescent HIV clinic in Washington, DC. AIDS Behav. Published online October 16, 2023. doi:10.1007/s10461-023-04209-7