Michael E Ohl1,2,3, Kelly Richardson1,2, Maria C Rodriguez-Barradas4, Roger Bedimo5, Vincent Marconi6,7,8, Jamie P Morano9,10, Michael P Jones11, Mary Vaughan-Sarrazin1,3. 1. Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa. 2. Veterans Rural Health Resource Center - Iowa City, Iowa City, Iowa. 3. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 4. Michael E. Debakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas. 5. VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas. 6. Atlanta Veteran Affairs Medical Center, Atlanta, Georgia. 7. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia. 8. Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia. 9. James A. Haley Veterans Affairs Hospital, Tampa, Florida. 10. Division of Infectious Diseases and International Medicine, Morsani School of Medicine, University of South Florida, Tampa, Florida. 11. Department of Biostatistics, University of Iowa, Iowa City, Iowa.
Abstract
BACKGROUND: Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. METHODS: In 2015-2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and <200 copies/mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available. RESULTS: Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30). CONCLUSIONS: Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens.
BACKGROUND: Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. METHODS: In 2015-2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and <200 copies/mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available. RESULTS: Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30). CONCLUSIONS: Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens.
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