How Telemedicine can Support HIV Prevention
Applying technology to deconstruct healthcare barriers holds promise in many different areas, including HIV prevention. The state of HIV prevention has changed drastically in the last decade, particularly due to the FDA’s 2012 approval of Truvada for use as pre-exposure prophylaxis (PrEP). PrEP is a way to prevent HIV infection before it occurs and has been particularly effective in the United States, where HIV incidence has decreased from 13.2 per 100,000 people in 2012 to 11.8 in 2017. This decrease in diagnosis, however, has not been equitable across all populations--the average PrEP user is more likely to be white and middle-aged. Young Black and Latino men who have sex with men have been largely isolated from the benefits of PrEP, despite being disproprotionately represented by new HIV cases. Socioeconomic disparities and systemic racism make this revolutionary measure of prevention unaccessible to a significant portion of the population. Telemedicine, the use of electronic information and communication to support long-distance clinical care, has been used in an attempt to combat these disparities.
Researchers at the David Geffen School of Medicine at UCLA conducted a narrative review, a comprehensive analysis of previous research, to assess the current state of telemedicine in HIV prevention and PrEP administration. Specifically, they looked at the academic Iowa TelePrEP and UCLA-led PrEPTech programs, in addition to the commercial Nurx and PlushCare programs. All four aimed to provide consultation access for starting PrEP, laboratory tests, and PrEP prescription and delivery. The discreteness and convenience provided by this technology helped reduce stigma associated with HIV infection and increased the likelihood of participants attending virtual visits, an important step to accessing care.
Researchers at the David Geffen School of Medicine at UCLA conducted a narrative review, a comprehensive analysis of previous research, to assess the current state of telemedicine in HIV prevention and PrEP administration. Specifically, they looked at the academic Iowa TelePrEP and UCLA-led PrEPTech programs, in addition to the commercial Nurx and PlushCare programs. All four aimed to provide consultation access for starting PrEP, laboratory tests, and PrEP prescription and delivery. The discreteness and convenience provided by this technology helped reduce stigma associated with HIV infection and increased the likelihood of participants attending virtual visits, an important step to accessing care.
Telemedicine HIV prevention was found to be effective in reaching populations made vulnerable by barriers to care and retaining PrEP use at the 6 months mark. Roughly half of the participants in Nurx and PrEPTech were young Black or Hispanic men. Many of the participants in Iowa’s TelePrEP study lived in rural areas, and the technology was required to work at a low-bandwidth to accommodate this. Thus, telemedicine appears to be an effective way to provide access to communities that would normally not benefit from such health programs due to both socioeconomic and geographical barriers. The 6 month retention rates for these studies were also promising, ranging from 76.2–98.7%. Unfortunately, the sample sizes from these studies were all fairly small, resulting from limiting factors of funding and costs. As there is no federal support for PrEP availability, telemedicine programs will not be able to run as effectively in states that do not guarantee financial coverage. Thus, the researchers suggest the passage of the PrEP-AP legislation to establish a federal grant program to solve the financial issues in current telemedicine HIV prevention programs. They indicate that the technology infrastructure of the existing for-profit telemedicine organizations, which have the greatest outreach capability, would benefit greatly from the investment of governmental agencies.
As a result of the COVID-19 pandemic, many clinics were forced to quickly adopt telemedicine far in advance of what was anticipated. A great deal of adjustments still need to be made, but the fact that a transition to remote services can occur in such a short time period demonstrates the potential of telemedicine to transform healthcare. Telemedicine in HIV prevention is one area among many that will hopefully make healthcare more accessible to all.
As a result of the COVID-19 pandemic, many clinics were forced to quickly adopt telemedicine far in advance of what was anticipated. A great deal of adjustments still need to be made, but the fact that a transition to remote services can occur in such a short time period demonstrates the potential of telemedicine to transform healthcare. Telemedicine in HIV prevention is one area among many that will hopefully make healthcare more accessible to all.
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