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BARRIERS IMPACTING TELEHEALTH MEDICAL-APPOINTMENT ADHERENCE AMONG PLWHA
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CROI 2020 March 6-10 reported by Jules Levin
Nicole Ennis1, Laura Armas2, Seyram Butame1
1Florida State University, Tallahassee, FL, USA, 2CAN Community Health, Sarasota, FL, USA
Background: Access to medical treatment and care for those living with or at risk for HIV is vital to ensuring quality of life and limiting the spread of
the disease. Lack of access to medical care is associated with poor disease management, antiretroviral medication failure, and increased incidence of ER visits and/or hospitalizations. To address the medical care needs of patients living with HIV providers have adapted to telehealth protocols that have allowed them to examine, assess and treat patients using secure 2-way video platforms with audio capabilities. While telehealth has been successfully implemented
for patients in routine care, lack of access due to the digital divide has not been closely examined. The goal of the current study was to characterize the response of patients to telehealth during the first six months of active telehealth care.
Methods: Due to COVID-19 pandemic CAN community clinics transitioned to video telehealth visits. Appointment adherence data for this study was taken from the electronic health record appointment using April 1, 2020-Ocotober 31, 2020 timeframe. No shows, cancellations and rescheduled appointments were excluded.
Results: We identified 5,470 unique patients who completed a total of 12,345 visits at CAN community locations, 80% of clinics were located in Florida. The average age of the population 48.62 yrs with SD of 13.37 yrs with range of 16 yrs - 88 yrs. 88% of patients had a confirmed HIV diagnosis and 12% of patients were on PrEP, majority (78%) identity as male, 62% identify as MSM, and 60% identified as White. Descriptive analysis shows that Blacks were 15% and those who identify as heterosexual were 24% more likely to have failed telehealth appointments (FT). FT decreased as in-person (IP) appointments increased. Apr (FT 48% v. IP 5%) May (FT 53% v. IP 4%); Jun (FT 32% v. IP 7%); Jul (FT30% v. IP 8%); Aug ( FT 28% v. IP 13%); Sept (FT 15% v IP28%); Oct (FT 8% v. IP 50%).
Conclusion: Currently, approximately three-in-ten adults with household incomes below $30,000 a year don't own a smartphone and more than four-in- ten don't have home broadband services (44%) or a computer (46%). Those who often have the most to gain from telehealth approaches are also the least likely to have access to broadband and/or cannot afford the necessary technology to engage in 2 way video telehealth appointments. Our work demonstrates that to serve the most vulnerable populations living with HIV more needs to be done to address the digital divide.
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