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HIV care using differentiated service delivery during the COVID-19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs.
McGinnis, Kathleen A; Skanderson, Melissa; Justice, Amy C; Akgün, Kathleen M; Tate, Janet P; King, Joseph T; Rentsch, Christopher T; Marconi, Vincent C; Hsieh, Evelyn; Ruser, Christopher; Kidwai-Khan, Farah; Yousefzadeh, Roozbeh; Erdos, Joseph; Park, Lesley S.
  • McGinnis KA; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Skanderson M; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Justice AC; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Akgün KM; Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Tate JP; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • King JT; Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Rentsch CT; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Marconi VC; Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Hsieh E; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Ruser C; Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Kidwai-Khan F; VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.
  • Yousefzadeh R; Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Erdos J; Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Park LS; Emory University School of Medicine, Rollins School of Public Health, and the Atlanta VA Medical Center, Atlanta, Georgia, USA.
J Int AIDS Soc ; 24 Suppl 6: e25810, 2021 10.
Article in English | MEDLINE | ID: covidwho-1487489
ABSTRACT

INTRODUCTION:

The Department of Veterans Affairs (VA) is the largest provider of HIV care in the United States. Changes in healthcare delivery became necessary with the COVID-19 pandemic. We compared HIV healthcare delivery during the first year of the COVID-19 pandemic to a prior similar calendar period.

METHODS:

We included 27,674 people with HIV (PWH) enrolled in the Veterans Aging Cohort Study prior to 1 March 2019, with ≥1 healthcare encounter from 1 March 2019 to 29 February 2020 (2019) and/or 1 March 2020 to 28 February 2021 (2020). We counted monthly general medicine/infectious disease (GM/ID) clinic visits and HIV-1 RNA viral load (VL) tests. We determined the percentage with ≥1 clinic visit (in-person vs. telephone/video [virtual]) and ≥1 VL test (detectable vs. suppressed) for 2019 and 2020. Using pharmacy records, we summarized antiretroviral (ARV) medication refill length (<90 vs. ≥90 days) and monthly ARV coverage.

RESULTS:

Most patients had ≥1 GM/ID visit in 2019 (96%) and 2020 (95%). For 2019, 27% of visits were virtual compared to 64% in 2020. In 2019, 82% had VL measured compared to 74% in 2020. Of those with VL measured, 92% and 91% had suppressed VL in 2019 and 2020. ARV refills for ≥90 days increased from 39% in 2019 to 51% in 2020. ARV coverage was similar for all months of 2019 and 2020 ranging from 76% to 80% except for March 2019 (72%). Women were less likely than men to be on ARVs or to have a VL test in both years.

CONCLUSIONS:

During the COVID-19 pandemic, the VA increased the use of virtual visits and longer ARV refills, while maintaining a high percentage of patients with suppressed VL among those with VL measured. Despite decreased in-person services during the pandemic, access to ARVs was not disrupted. More follow-up time is needed to determine whether overall health was impacted by the use of differentiated service delivery and to evaluate whether a long-term shift to increased virtual healthcare could be beneficial, particularly for PWH in rural areas or with transportation barriers. Programmes to increase ARV use and VL testing for women are needed.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / HIV Infections / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Int AIDS Soc Journal subject: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Year: 2021 Document Type: Article Affiliation country: Jia2.25810

Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / HIV Infections / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Int AIDS Soc Journal subject: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Year: 2021 Document Type: Article Affiliation country: Jia2.25810