HIV Specialist - March 2021 - 19

1. Give patients more control. Patients
should be able to decide where, when and
how to access services. Providers also
should be given more flexibility in responding to patients and more tools to overcome
barriers to care, such as transportation
barriers or the constraints of normal office
hours. Doing so will increase privacy, reduce
stigma and provide better support to providers when delivering telehealth services.
2. Promote equity. Policy attention is
needed to ensure equitable access to
smartphones, broadband access and other
technology for all individuals and community-based organizations, but especially
those of racial and ethnic minorities,
LGBTQ+ individuals, persons in rural
areas and immigrants.
3. Expand shared learning. Clinics and providers need new opportunities for shared
learning to circulate best practices while
also working to avoid common pitfalls. With
greater experience with telehealth, model
practices are emerging that can serve as a
useful guide to providers across the country.
4. Invest in research. Continued research is
needed to learn more about which services
are most useful and desired by which patient
populations; establish best practices around
in-person visit frequency; develop differentiated care models that allocate more time and
resources to subsets of people with greater
barriers to care; and determine cost-effective approaches to telehealth services.
Introducing telehealth services into HIV
prevention and care programs is an important opportunity to improve outcomes and
increase client and provider satisfaction.
For telehealth to be a viable and sustainable
option and become an integral part of HIV
service delivery, it will require upfront investments in technology, an understanding of the
regulatory environment and adaptations to
the service and billing models. Although the
COVID-19 pandemic has allowed Congress
to remove some of the pre-existing regulatory
barriers to using telehealth services, inequities, such as the persisting Digital Divide,
must be addressed now, as well as after the
COVID-19 emergency is over. Doing so can
help to improve engagement in care and
achieve positive health outcomes. HIV

Self-collected Lab Testing
Is an Important Innovation
IF TELEHEALTH AND THE MOVE OUT OF THE CLINIC for the delivery of critical
services is an important innovation that can improve outcomes, then the ability to enable
individuals to self-collect samples for HIV testing, sexually transmitted infections (STI)
screenings and other routine screenings can be a critical advancement. The ability to
conduct home self-collection and have these services covered by insurance has the
potential to improve access to care and contribute to the sustained use of telehealth
services in clinical practices.
Do individuals want the option of at-home self-collection? Yes. As one example,
early studies have affirmed support for pre-exposure prophylaxis (PrEP) treatment as well
as PrEP@Home testing, if this service was available.(a)
What are the potential advantages with home self-collection?
1. There is no need to travel to a clinic or schedule an appointment.
2. Collecting specimens at home offers privacy and helps to reduce stigma-related
avoidance of clinical settings.
3. It provides an option for specimen collection for those individuals who would otherwise not
have access to a proximate, welcoming clinic or provider that offers PrEP services.(b)
What, if any, potential challenges regarding home self-collection have arisen so
far? Although home-based sample collection has proven to be safe and has been held
to the same accuracy standards as traditional testing, labs analyzing samples collected
at home are also being held to stringent standards by the Food and Drug Administration
(FDA), thus limiting the willingness of some insurers to cover these tests.(c)
Self-collection lab testing is likely to grow in importance. With consumer demand
increasing, more labs ready to accept and analyze these tests and more insurers willing to
reimburse for these costs as an alternative to clinic-based testing, this new flexible option
for patients can increase PrEP adherence and expand the reach of HIV testing.
SOURCES: (a) Aaron J Siegler, et al., Developing and Assessing the Feasibility of a Home-based Preexposure
Prophylaxis Monitoring and Support Program, 68 Clin Infect Dis. 501-04 (Jan. 18, 2019), doi: 10.1093/cid/ciy529. (b)
At-home Self-Collection Lab Testing for Sexually Transmitted Infections, National Coalition of STD Directors, www.
ncsddc.org/wp-content/uploads/2020/06/NCSD-TA-Brief-Home-STI-Testing-Care-FAQ-v5.20.2020.pdf (last
updated May 20, 2020). (c) Id.

LANDON MYERS, JD, is a fellow with
the HIV Policy Project at the O'Neill
Institute for National and Global Health
Law at Georgetown Law. This article was
adapted from an Institute brief, Big Ideas:
Integrating Telehealth Into HIV Services Systems Can
Help To Sustain Improved Outcomes, which is available
at https://oneill.law.georgetown.edu/projects/
national-hiv-aids-initiative/hiv-publications/.

REFERENCES
1. AMA Digital Health Research: Physician's motivation and
requirements for adopting digital health-adoption and
attitudinal shifts from 2016 to 2019, A MERICAN M EDICAL
A SSOCIATIOn (Feb. 2020), https://www.ama-assn.org/
system/files/2020-02/ama-digital-health-study.pdf.
2. See, e.g., Brooke G Rogers, et al., Development of
telemedicine infrastructure at an LGBTQ+ clinic to
support HIV prevention and care in response to COVID-19,
24 AIDS BEHAV. 2743-47 (Oct. 2020), doi: 10.1007/
s10461-020-02895-1.

3. Telemedicine and Telemedicine, H EALTH IT.GOV, https://
www.healthit.gov/topic/health-it-health-care-settings/
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health%2Drelated%20education%2C%20public (last
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4. Id.
5. COVID-19: Using Telehealth to Expand Access to Essential
Health Services during the COVID-19 Pandemic, CENTERS
FOR DISEASE CONTROL AND PREVENTION, https://www.
cdc.gov/coronavirus/2019-ncov/hcp/telehealth.
html#edn3 (last updated June 10, 2020).
6. Gabriela Weigel, et al., Opportunities and Barriers for
Telemedicine in the U.S. During the COVID-19
Emergency and Beyond, K AISER FAMILY FOUNDATION
(May 11, 2020), https://www.kff.org/womens-healthpolicy/issue-brief/opportunities-and-barriers-fortelemedicine-in-the-u-s-during-the-covid-19-emergencyand-beyond/.
7. Nicol Turner Lee, Jack Karsten & Jordan Roberts,
Removing Regulatory Barriers to Telehealth Before and
After COVID-19, BROOKINGS I NSTITUTION AND JOHN
LOCKE FOUNDATION (May 6, 2020, https://www.
brookings.edu/research/removing-regulatory-barriers-totelehealth-before-and-after-covid-19/.
8. Id.

WWW.AAHIVM.ORG

HIVSPECIALIST

MARCH 2021

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HIV Specialist - March 2021

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