Telemedicine for HIV Care: Current Status and Future Prospects.
Telemedicine for HIV Care: Current Status and Future Prospects.
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DOI：
10.2147/hiv.s277893
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Badowski ME
中科院分区：
文献类型：
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作者：
Smith E;Badowski ME
由于COVID-19大流行，远程医疗的使用得到了强调，特别是在艾滋病毒管理等专业。最近的数据是在2019年1月1日至2021年3月20日期间通过搜索英文手稿来审查的，这些研究记录了艾滋病毒护理的临床结果和患者体验。基于检索词“HIV”、“远程医疗”和“远程保健”进行了PubMed、Google Scholar和参考文献审查。本分析所包括的研究包括通过远程医疗接受艾滋病毒护理的成年艾滋病毒感染者，报告了临床结果或使用远程医疗管理其艾滋病毒护理的看法。在确定的179项研究中，有12项符合本分析的入选标准。只有两项研究提供了关于艾滋病毒临床结局（病毒学结局）的数据，一项在大流行前，另一项在COVID-19期间。评估COVID-19期间病毒抑制的研究显示，与大流行开始前相比，发出就地安置命令后，病毒抑制率和错过预约率均较低。其余的研究侧重于与患者相关的结果，因为它们与远程保健模式的可用性和采用有关。许多实践记录了远程医疗的好处和局限性，远程医疗的基础是从传统的面对面诊所快速转换。好处包括为居住在远离诊所的病人保留护理，为不想被看到参加艾滋病毒诊所的病人提供隐私，以及在安排预约方面更灵活。一些限制包括患者获得技术的机会、使用技术的能力和意愿，以及无家可归和居住在收容所的患者的隐私，在收容所，艾滋病毒感染者的无家可归人数是普通人群的三倍。应通过评估患者的需求和局限性，为患者量身定制医疗保健服务，特别是那些可能面临中断护理风险的患者，尤其是无家可归的患者。此外，关于年龄、性别和种族等因素的数据参差不齐，这些因素是使用技术意愿的限制因素。从回顾的研究来看，参与技术的意愿并不因年龄、性别或种族而异，但确实因使用技术的途径和意愿而异。更大的限制是获得适当的远程医疗和数字扫盲设备。尽管在COVID-19大流行期间，诊所转向远程医疗存在困难，但许多患者表示对护理感到满意，并有兴趣在取消就地避难令后继续使用。今后的研究应侧重于在大流行病之后利用远程医疗提供艾滋病毒护理，并侧重于如何改善患者的远程医疗体验。
Due to the COVID-19 pandemic, the use of telemedicine has been highlighted, especially in specialties, such as the management of HIV. Recent data were reviewed between January 1, 2019 and March 20, 2021 by searching English language manuscripts for studies documenting clinical outcomes in HIV care and the patient experience. A PubMed, Google Scholar, and bibliography review based on the search terms “HIV,” “telemedicine,” and “telehealth” was conducted. Studies included in this analysis were comprised of adult patients living with HIV, receiving care for HIV via telemedicine with reported clinical outcomes or perceptions of using telemedicine in the management of their HIV care. Of the 179 studies identified, 12 met inclusion for this analysis. Only two studies provided data on clinical outcomes of HIV (virologic outcomes), one pre-pandemic and one during COVID-19. The study evaluating viral suppression during COVID-19 demonstrated lower rates of virologic suppression and lower rates of missed appointments when shelter-in-place orders were issued compared to before the start of the pandemic. The remaining studies focused on patient-related outcomes as they related to the usability and adoption of telehealth models. Many practices documented the benefits and limitations of telemedicine based on the rapid switch from traditional in-person clinics. Benefits included retention in care for patients who lived a far distance from clinic, privacy for patients not wanting to be seen attending an HIV clinic, and more flexibility in scheduling appointments. Some limitations included patients’ access to technology, ability and willingness to use technology, and privacy of patients who are homeless and reside in a shelter where homelessness is 3 times greater in people living with HIV compared to the general population. Healthcare should be tailored to the individual patient by assessing their needs and limitations, particularly with patients who may be at risk for discontinuation of care, particularly in the homeless population. In addition, there are mixed data on factors such as age, sex, and race being limiting factors in willingness to use technology. From the studies reviewed, willingness to engage with technology did not differ by age, sex, or race but did differ by access and willingness to use technology. Greater limitations were access to appropriate devices for telemedicine and digital literacy. Although there have been difficulties with the switch to telemedicine in clinics during the COVID-19 pandemic, many patients have reported being satisfied with care and would be interested in continuing once the shelter-in-place order is lifted. Future studies should focus on the provision of HIV care using telemedicine beyond the pandemic and focus on ways to improve the telemedicine experience for the patient.