HIV care using differentiated service delivery during the COVID-19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs

• Type of Material: Article
• Authors: Kathleen A McGinnis, US Department of Veterans Affairs; Melissa Skanderson, US Department of Veterans Affairs; Amy C Justice, US Department of Veterans Affairs; Kathleen M Akgün, US Department of Veterans Affairs; Janet P Tate, US Department of Veterans Affairs; Joseph T King, US Department of Veterans Affairs; Christopher T Rentsch, US Department of Veterans Affairs; Vincent Marconi, Emory University; Evelyn Hsieh, US Department of Veterans Affairs; Christopher Ruser, US Department of Veterans Affairs; Farah Kidwai-Khan, US Department of Veterans Affairs; Roozbeh Yousefzadeh, US Department of Veterans Affairs; Joseph Erdos, US Department of Veterans Affairs; Lesley S Park, Stanford School of Medicine
• Language: English
• Date: 2021-10-01
• Publisher: JOHN WILEY & SONS LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/jia2.25810
• Title of Journal or Parent Work: JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
• Volume: 24
• Issue: S6
• Start Page: e25810
• End Page: e25810
• Grant/Funding Information: This study was funded by the National Institute on Alcohol Abuse and Alcoholism (grants U24‐AA020794, U01‐AA020790 and U10‐AA013566‐completed), Emory University Center for AIDS Research (grant P30AI050409) and the United States Department of Veterans Affairs Health Services Research & Development (grant C19 21‐287).; The funders of this study had no role in study design, data collection, analysis, interpretation and presentation or in the decision to submit the manuscript for publication. Views presented in the manuscript are those of the authors and do not reflect those of the Department of Veterans Affairs, or the US Government.
• Keywords: extended refills; veterans; Life Sciences & Biomedicine; Infectious Diseases; Science & Technology; Immunology; HIV; COVID-19; virtual visits
• Research Categories: Health Sciences, Public Health

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.