ACCESS TO AND EXPERIENCES OF REMOTE HIV CLINICAL SERVICES IN HIGH-INCOME SETTINGS: A SCOPING REVIEW

Background Remote delivery of HIV services (often facilitated by digital technology) has increased over recent years, especially in response to the COVID-19 pandemic. Using scoping methods, we synthesise current knowledge about remote HIV healthcare services. Methods We systematically searched literature using multiple databases, supplementing this with searches of grey literature. We included papers reporting on empirical studies in high income countries (OECD) of remote HIV healthcare delivery by digital technology including mobile apps, video, SMS and telephone. We extracted data using a standardised tool and analysed data thematically. Results A large proportion of studies focus on interventions supporting antiretroviral therapy adherence, often via mobile apps or SMS. There has been a recent uptick in work describing remote routine HIV clinical appointments in the context of COVID-19. There was a dearth of evidence on the impact of remote HIV healthcare services on clinical and patientreported outcomes, as well as factors shaping access to remote HIV healthcare services. Discussion There is an increasingly large body of work investigating remote HIV healthcare services, much of it focusing on adherence support. Less is known on barriers to and facilitators of remote HIV healthcare service provision and access, and how these services impact patient experience and outcomes. Given the enduring change to models of HIV healthcare as a result of COVID-19, we urgently require a robust evidence-base to inform inclusive, equitable and effective service design.

Healthcare contacts with self-harm during COVID-19: An e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016-March 2021.

INTRODUCTION: Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. OBJECTIVES: To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care. METHODS: This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (µROR) across years was reported. RESULTS: The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (µROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (µROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (µROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (µROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (µROR = 0.5, p<0.05). CONCLUSIONS: These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.

Exploring the data-sharing ecosystem in HIV care: Healthcare professionals' beliefs and practices

Background: Understanding data-sharing in HIV care is timely given the shift to remote consultations during COVID-19 and increasing expectations for self-management. We describe the 'data-sharing ecosystem' in HIV care by analysing HIV healthcare professional (HCP) beliefs and practices around sharing diverse types of service user and clinic-generated data across multiple contexts. Method: During February-October 2020, we conducted 14 semi-structured interviews with HCPs working in a large UK HIV outpatient service. Participants engaged in a card sorting task, sorting 33 data types routinely shared in HIV care into categories (comfortable/not comfortable/ not sure) across three data-sharing contexts: (a) from service users to HCPs in consultations;(b) HCPs to GPs;and (c) HCPs to non-HIV HCPs. Data were analysed thematically. Results: Over half (57%) of participants were female;57% were doctors. Participants had worked in HIV for 12 years on average. HCPs were comfortable with a wide range of data being shared with them by service users. Across all sharing contexts, HCPs were uncomfortable with sharing of service user photographs, perceiving them as not routinely shared, unnecessary, and potentially risking inadvertent sharing of inappropriate content. HCPs were comfortable sharing data with GPs and other non-HIV HCPs in two broad categories: (a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep). HCPs were less comfortable sharing sensitive information about HIV status, sexual health, behaviour and identity, perceiving them as not relevant to care provided by other HCPs or as risking stigmatisation. Service user consent and relevance of data to sharing context were key determinants of data-sharing comfort. Conclusion: With a growing emphasis on self-management of HIV and on remote care provision, understanding the context of data-sharing in HIV care is increasingly important, particularly given the perceived durability of some current service changes as a result of COVID-19. We demonstrate the complex interplay of data types, relationship dynamics, and contexts of care provision that shape the data-sharing ecosystem in HIV care. Developing guidance on the sharing of service user and clinic-generated data in HIV care must account for these complexities.

Exploring the data-sharing ecosystem in HIV care: healthcare professionals' beliefs and practices

Background Understanding data-sharing in HIV care is timely given the shift to remote consultations during COVID-19. We describe the 'data-sharing ecosystem' in HIV care by analysingHIV healthcare professional (HCP) beliefs and practices around sharing diverse types of service user and clinic-generated data across multiple contexts. Methods During February-October 2020, we conducted 14 semi-structured interviews with HCPs working in a large UK HIV outpatient service. Participants engaged in a card sorting task, sorting 33 data types routinely shared in HIV care into categories (comfortable/not comfortable/not sure) across three data-sharing contexts: (a) service users to HCPs in consultations;(b) HCPs to GPs;(c) HCPs to non-HIV HCPs. Data were analysed thematically. Results Over half (57%) of participants were female;57% were doctors. Participants had worked in HIV for 12 years on average. HCPs were comfortable with a wide range of data being shared with them by service users. Across all sharing contexts, HCPs were uncomfortable with sharing of service user photographs, perceiving them as not routinely shared, unnecessary, and potentially risking inadvertent sharing of inappropriate content. HCPs were comfortable sharing data with GPs and other non-HIV HCPs in two broad categories: (a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep). HCPs were less comfortable sharing sensitive information about HIV status, sexual health, behaviour and identity. Service user consent and relevance of data to sharing context were key determinants of data-sharing comfort. Conclusion Understanding the context of data-sharing in HIV care is increasingly important given the shift to remote consultations and expectations for self-management. We demonstrate the complex interplay of data types, relationship dynamics, and contexts of care provision that shape the data-sharing ecosystem in HIV care. Developing guidance on the sharing of service user and clinic-generated data in HIV care must account for these complexities.

Life under coronavirus: Children’s views on their experiences of their human rights

Children have a right to have their views sought and given due weight on all matters affecting them, including at times of emergency and crisis. This article describes the process and findings of the ground-breaking CovidUnder19 survey (“Life Under Coronavirus”) which was co-designed with children for children, capturing the experiences of over 26,000 children in 137 countries as to the realisation of their human rights during the first six months of the Covid-19 pandemic. Key findings are discussed through the lens of the crc’s four general principles, read alongside children’s rights, inter alia, to education, play and to be protected from harm. It argues that governments and public bodies should have sought children’s views – not just because they were under an obligation to do so – but because such engagement, now and in crises to come, provides an early warning system that enables decision-makers to mitigate some of the adverse consequences of their responses for children and their rights. © Laura Lundy et al., 2021