HIV Specialist - March 2021 - 25

are now virally suppressed (all were previously detectable), and six have had at least
two visits or more. Three of the patients
were updated to newer HIV medications due
to previously unidentified side effects and
drug-drug interactions. All patients stated
either transportation or lack of HIV care in
their community as the reason for choosing
this model. Although the cohort is small, it is
already demonstrating promising results.
There are several benefits afforded to both
the patient and the provider with either model. Both improve access for those restricted
via geography or disabilities. Patients have
reduced or no transportation costs (driving,
parking, public transportation, etc.) which
removes a huge barrier to retention in care.
Patients served by the second model get
linked to HIV subspecialists which leads to
increased virologic suppression, reduction in
HIV-related comorbidity and mortality and
transmission to others. By bringing the care
to their local area, patients in rural HPSA are
less stigmatized. These models are especially
helpful for certain types of visits: check-ins,
medication monitoring, and counseling. The
second model is even more beneficial when
there are exam findings involved. Both the
patient and provider have a choice in selecting telemedicine vs in-person visit with the
first model thus providing some autonomy.
This leads to increased patient and provider
satisfaction. Providers also experience less
burnout due to flexible schedules and ability
to work from home.
Despite the wide variety of benefits,
telehealth does have several limitations and
many considerations (Figure 1). There exists
a digital divide especially amongst the aging
HIV population and although instructions

and software walk-throughs can be conducted, a large part of the visit can be spent
overcoming the technological issues. The
technology isn't perfect and privacy concerns
still persist along with challenges in incorporating telehealth for non-English speaking clients. There are many hidden costs
including licensure, software, hardware,
staffing, training, and call coverage which can
add up without the backing of a large health
system. Triaging patients i.e. " Who is right
for this visit? " is an acquired skill. Clients
with unstable housing may not have a safe
way to conduct a video visit and rely on telephone visits. New patients should ideally be
seen in-person or at a telemedicine clinic for
the first visit to allow a proper introduction.
Home video visits lead to limited physical
exam and delay in labs and preventative care.
Lastly, despite all the advances, telemedicine
cannot overcome the human touch as established in a face to face visit.
Although telehealth has been practiced
for years, it really rose to prominence due to
the ongoing pandemic. Our models already
show favorable outcomes in terms of promoting retention in care, improved value by
reducing costs and increasing quality of care,
and expanding the clinic's reach. Current

and future plans include implementation of
video visits with behavioral health and nutrition, expansion of the telemedicine clinical
locations to other rural areas, and continuing
to assess the effectiveness of telehealth care
delivery by monitoring viral load suppression and retention in care. These plans are
also dependent upon the ever-changing landscape of billing and reimbursement rules
which may evolve further as the pandemic
rages. Regardless, telehealth is here to stay
for the foreseeable future thus we all have to
adapt. HIV
DR. NUPUR GUPTA is a HIV and
general Infectious Disease clinician at the
University of Pittsburgh Medical Center
in Pittsburgh, Pa. She provides HIV and
ID care inpatient and outpatient care as
well as via telemedicine in rural Pennsylvania.

DR. DEBORAH MCMAHON is the
Clinical Director of the UPMC HIV/AIDS
Program in Pittsburgh, Pa. She serves as
the Project Director for the HRSA
funded-Ryan White program and
oversees a team of physicians, mental health
specialists, HIV pharmacist, social workers, and
nutritionist. Her research focuses on the HIV reservoir
and eradication strategies and has several NIH-funded
ACTG studies.

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HIV Specialist - March 2021

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