HIV Specialist - March 2021 - 14

TOGETHER WHILE APART

inclement weather, traffic or other transportation issues. Enhanced
efficiency may also permit increased availability of and flexibility with
scheduled appointments, and less time spent travelling, waiting and
away from work for patients. With these advantages, it is no wonder
that many urban and suburban patients and providers have embraced
telehealth services for their regular follow-up care.

Reducing Care Disparities

Underserved populations, including those afflicted with poverty, who
have been disproportionately affected by the dual pandemics of HIV
and COVID-19, by definition have also suffered disproportionally the
effects of limited access to HIV specialty services. Although 80 percent
of all U.S. households have access to the internet, data from the Health
Information National Trends Survey suggest that significant disparities in internet access exist by age, sex, race, ethnicity, income, and
education. Likewise, as noted in AHRQ's 2018 National Healthcare
Quality and Disparities Report, while some of the observed disparities
have declined over the past two decades, many persist, especially for
poor and uninsured populations in all priority areas.6
With the possibility of broadening access to HIV specialty services to traditionally underserved populations, telehealth can help
to reduce healthcare disparities. Nevertheless, it has become very
clear through early efforts to establish remote learning and virtual
workplace environments in addressing the COVID-19 pandemic that
much good work remains to be done to enhance the equitable availability of broadband internet access. As telehealth and other essential
digital services continue to grow and progress in the 21st century,
accomplishing that work will become even more critical. If telehealth
is to take its rightful place among the tools for reducing disparities in
access to quality healthcare, disparities in access to the internet and
digital technologies must first be eliminated.

Managing Biopsychosocial Dimensions

Telehealth has certainly become an important tool in our clinical
toolkit. Nonetheless, it is not always appropriate for every task. On
occasion, patients and providers may feel less comfortable with some
of the logistical aspects of telehealth, particularly in addressing complex psychosocial and medical issues. Carving out personal space for
private telehealth visits may be more challenging for some individuals
due to housing issues. Practitioners in HIV medicine care for a disproportionately large number of individuals whose health outcomes
are affected by social determinants of health, including race, ethnicity,
gender, income, housing stability, mental health, substance use, education, language, incarceration history, and others. These same social
determinants as well as English language skills predict digital health
readiness.7
Although telehealth services alone may not prove optimal or even
sufficient in every instance, experience in recent years and particularly
over the past year has clearly demonstrated the value that these services may provide in the broader context of HIV care. This is especially
the case for individuals who have previously established care with a
knowledgeable and trusted provider with whom ongoing follow-up
via telehealth can be maintained. Indeed, outcomes for individuals

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MARCH 2021   HIVSPECIALIST  WWW.AAHIVM.ORG 

In battling the dual pandemics of
HIV/AIDS and SARS-CoV-2/COVID-19,
telehealth has offered numerous
important opportunities to address
critical challenges in delivering care for
individuals living with HIV.
on antiretroviral therapy (ART) in terms of
adherence and clinical response to therapy, psychological and emotional states and
quality of life have been demonstrated to be
similar for individuals utilizing telehealth and
in-person visits.8

Bridging the Digital Divide

Technology literacy and access may be limiting factors in the successful implementation
of telehealth services, particularly for those
who struggle with poverty. Individuals living
with HIV infection are disproportionately
impacted by poverty, and would be expected
to be at risk for substantial challenges to the
availability of and facility with the necessary
technological components of telehealth
services. The digital divide has been painfully
evident in the many challenges presented by
the COVID-19 pandemic, which has rapidly
driven the necessity to conduct so much of
daily life online. With so much at stake, we
are challenged now more than ever as a society to ensure that the fruits of technological
advances are more equitably distributed.

ISTOCK/ RIDOFRANZ
http://WWW.AAHIVM.ORG
HIV Specialist - March 2021

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