COVID-19, Telemedicine, and Patient Empowerment in HIV Care and Research
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COVID‑19, Telemedicine, and Patient Empowerment in HIV Care and Research Ofole Mgbako1,2 · Emily H. Miller1 · Anthony F. Santoro2 · Robert H. Remien2 · Noga Shalev1 · Susan Olender1 · Peter Gordon1 · Magda E. Sobieszczyk1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Beyond the tragic loss of life, the COVID-19 pandemic has disrupted HIV care delivery throughout the U.S. To meet the needs of people living with HIV/AIDS (PLWHA) along the care continuum, health systems have expanded the use of telemedicine (e.g., video, telephone visits) to maintain HIV treatment adherence and care engagement. Despite some promising early results [1, 2], providers must consider the implications of telemedicine on the patient-provider relationship and the establishment of trust in ongoing care, particularly for the most vulnerable. An approach focused on patients’ values and preferences provides an opportunity to empower PLWHA in this new paradigm of HIV care. As HIV primary care physicians and researchers working in New York City, we have grappled with the benefits and challenges of telemedicine as we seek continuity in our work during the COVID-19 pandemic. The move toward telemedicine in HIV care has increased over the past decade [2, 3]. A recent study of 371 PLWHA found 57% of respondents were more likely to use telemedicine for their HIV care compared to in-person [4]. This sample was predominantly US-born, with a higher education level and perceived HIV-related stigma [4]. Broad acceptance of telemedicine may be true only in specific subgroups of PLHWA. Due to the notable health disparities in both the COVID-19 and HIV-1 pandemics, we believe it is important to work towards equitable models of HIV care [5]. In this paper, we present a patient case from our HIV clinic and
* Ofole Mgbako [email protected] 1
Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, USA
HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
2
explore the potential tradeoffs between patient-centered care and telemedicine.
View from the Clinic A young African American woman with uncontrolled HIV and multiple comorbidities presented for a follow-up video visit appointment. The patient was unemployed and fearful of leaving her apartment due to risk of COVID-19 given her compromised immune status. During the visit, the patient seemed stressed by multiple difficulties that arose with the video visit interface, including many connectivity disruptions; as a result, her appointment was converted to a telephone visit. During the call she reported possible side effects from her complicated antiretroviral treatment (ART) regimen. She also required specialty care for her other medical conditions. Her provider scheduled an in-person visit in one month. From the provider perspective, the patient had a complex HIV history and low health literacy, factors often associated
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