HIV Treatment Outcomes in Rural Georgia Using Telemedicine

Folake J Lawal; Moshood O Omotayo; Tae Jin Lee; Arni S R Srinivasa Rao; Jose A Vazquez

doi:10.1093/ofid/ofab234

HIV Treatment Outcomes in Rural Georgia Using Telemedicine

Open Forum Infect Dis. 2021 May 12;8(6):ofab234. doi: 10.1093/ofid/ofab234. eCollection 2021 Jun.

Authors

Folake J Lawal¹, Moshood O Omotayo^{2

3

4}, Tae Jin Lee⁵, Arni S R Srinivasa Rao⁶, Jose A Vazquez¹

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
² Centre for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.
³ Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
⁶ Laboratory for Theory and Mathematical Modeling, Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

Abstract

Background: The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model.

Methods: We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics.

Results: Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm³) than that of the F2F group (596.3 cells/mm³; P < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 10⁴ and -1 to 0.24 × 10⁴, respectively (P = 1.00).

Conclusions: TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.

Keywords: HIV; HIV outcomes; HIV treatment; rural medicine; telemedicine.