PLHIV
The median age of PLHIV completing interviews was 50 years (range 23–65). Twenty-one PLHIV (68%) identified as cisgender men, seven (22%) as cisgender women, and three (10%) as transgender women (Table
1). The majority of PLHIV identified as either Hispanic/Latino/a or Black/African-American (65%), with eleven (36%) identifying as Hispanic or Latino/a and nine (29%) identifying as Black or African-American. Most PLHIV were English-speaking (
N = 24, 78%), with the remainder (
N = 7, 22%) reporting Spanish as their primary language. Twenty-eight PLHIV (90%) had used telemedicine as part of their HIV care in the past year, and 24 of these PLHIV (86%) reported that their visits had been conducted over telephone only. Characteristics of telemedicine use are described in Table
2.
Table 1
Demographic Characteristics of PLHIV
Age, Median (IQR) | 50 (40–58) | 50 (32–57) | 51.5 (42.5–58.5) |
Gender, N (%) |
Cisgender female | 7 (22) | 2 (13) | 5 (31) |
Cisgender male | 21 (68) | 10 (67) | 11 (69) |
Transgender female | 3 (10) | 3 (20) | 0 (0) |
Race/Ethnicity, N (%) |
Black or African-American | 9 (29) | 1 (7) | 8 (50) |
Hispanic or Latino/a | 11 (36) | 5 (33) | 6 (37) |
Native American | 1 (3) | 1 (7) | 0 (0) |
White/Caucasian | 4 (13) | 3 (20) | 1 (6) |
Multi-racial | 6 (19) | 5 (33) | 1 (6) |
Primary language, N (%) |
English | 24 (78) | 13 (87) | 11 (69) |
Spanish | 7 (22) | 2 (13) | 5 (31) |
Years on ART, Median (IQR) | 8 (3–20) | 8 (3–23) | 8 (3–15) |
Employment status, N (%)a |
Working | 12 (39) | 6 (40) | 6 (37) |
Not working | 18 (58) | 8 (53) | 10 (63) |
Stable housing, N (%)a |
Yes | 27 (87) | 13 (87) | 14 (87) |
No | 3 (10) | 1 (7) | 2 (13) |
Table 2
Use of Telemedicine by PLHIV
Used telemedicine for HIV care in past year |
Yes | 28 (90) | 12 (80) | 16 (100) |
No | 3 (10) | 3 (20) | 0 (0) |
Mode of telemedicine used |
Telephone only | 24 (78) | 8 (53) | 16 (100) |
Video only | 2 (6) | 2 (13) | 0 (0) |
Both telephone and video | 2 (6) | 2 (13) | 0 (0) |
N/A (No use of telemedicine in past year) | 3 (10) | 3 (20) | 0 (0) |
Technological resources available |
Phone (no internet) | 1 (3) | 0 (0) | 1 (6) |
Smartphone (with internet) | 7 (22) | 3 (20) | 4 (25) |
Smartphone and computer | 23 (75) | 12 (80) | 11 (69) |
Number of in-person visits in prior year for HIV carea |
0 | 0 (0) | 0 (0) | 0 (0) |
1–2 | 7 (22) | 3 (20) | 4 (25) |
3–4 | 11 (36) | 4 (27) | 7 (44) |
5 or more | 13 (42) | 8 (53) | 5 (31) |
Number of telemedicine visits in prior year for HIV carea |
0 | 3 (10) | 3 (20) | 0 (0) |
1–2 | 14 (45) | 7 (47) | 7 (44) |
3–4 | 12 (39) | 5 (33) | 7 (44) |
5 or more | 2 (6) | 0 (0) | 2 (13) |
Use of telemedicine for other non-HIV careb |
Yes | 11 (36) | 10 (67) | 1 (6) |
No | 20 (64) | 5 (33) | 15 (94) |
The following themes emerged during thematic analysis of PLHIV interviews, which are addressed in detail below: time and costs associated with the care model; resources for telemedicine and technological literacy; access to privacy for telemedicine; impact of telemedicine on the interpersonal dynamic; interest in future telemedicine; and interest in video modality of telemedicine.
Time and costs associated with the care model
When asked about time spent seeking care, most PLHIV reported that using telemedicine (predominantly telephone) for their HIV care saved significant time because they did not need to commute to and from the clinic – “by telephone, you are at home…It saves you the time of going, the time of driving, whether you're going by bus, train, or your own transportation. It saves you time right there.” (Cisgender female, 59 years old, 2 years on ART)
Telemedicine visits also saved time spent waiting for the clinician. While participants did sometimes report a wait time for telemedicine appointments, this was shorter than for an in-person appointment. Respondents citing this benefit were mostly those who had been on ART for longer. One participant shared, “I don’t have a car so I need to take public transportation and it’s a bit over one hour commute. Plus, the wait time in reception, and the doctor, that takes an additional two or three hours—which I am saving now because telemedicine is coming to me and I don’t have to invest all that time.” (Cisgender male, 58 years old, 14 years on ART) Many PLHIV also shared that telemedicine saved money on transportation costs, including for public transportation, gas for a personal vehicle, or a rideshare such as Uber or Lyft. This was especially beneficial for patients who lived far from the clinic because, as one participant explained, “Going in person—it expends a lot of time, energy, money that I don’t really have because I’m up here in [North County] and their clinic is down in L.A. It’s a drive and I don’t have $200, $300 a month to throw away on gas.” (Cisgender male, 56 years old, 20 years on ART)
Some PLHIV also appreciated that telemedicine did not require taking any or as much time off work, and therefore resulted in fewer earnings losses as compared to in-person visits, stating, “[Telemedicine] saves me time, I don’t go to the clinic, I don’t have to ask for time off at work: ‘Tomorrow I’m going to come two hours later, I have an appointment,’ and so on.” (Cisgender male, 45 years old, 9 years on ART)
Resources for telemedicine and technological literacy
When PLHIV were asked about their ability to utilize telemedicine for HIV care, many felt able to successfully connect and engage in a telemedicine visit via telephone. While almost all (N = 30, 97%) PLHIV reported having access to either a smartphone, computer and/or tablet, as well as either mobile data and/or Wi-Fi, a few without access to these technological resources expressed frustration with their lack of access and desired better technology for telemedicine visits with video. This sentiment is shared by one study participant who desired more resources such as “access to a computer, or a tablet, or something. I don’t know. Because this phone thing is not really working for me.” (Cisgender male, 50 years old, 10 years on ART) Few PLHIV had experience with video visits; however, those that did reported few to no barriers. Some PLHIV reported experience with video visits for their mental health care, or video calls with their family and friends during the pandemic, and shared that there was a learning curve, but they quickly became confident in their ability to use video for these types of communication, with one participant stating that it “…wasn’t hard. All you did was you get this new app and then they send you a notification and that’s just a link, so it’s real simple.” (Cisgender male, 56 years old, 20 years on ART)
Access to privacy for telemedicine
PLHIV were asked if they had privacy for either telephone or video telemedicine visits. Many—particularly older interviewees—had consistent access to privacy in their household. As one participant expressed: “If I needed to do a Zoom call or a video conferencing, I will do it in my apartment because I live alone, so it is private.” (Cisgender male, 56 years old, 8 years on ART) Even though they had privacy at their homes, a few PLHIV liked that telemedicine might give them the opportunity to attend their visits in another location, describing that, “I can be at the beach, or I can be at a park. I can probably have a phone call in a location like that. It would really be nice to actually be out there. Normally, I’m at home, where it’s more quiet.” (Cisgender male, 34 years old, 5 years on ART) However, some PLHIV, particularly those who had not disclosed their HIV status and lived in shared housing, said that a lack of privacy was a major barrier for accessing telephone or video telemedicine for their HIV care, with one participant stating, “I'm in a transitional living home. Privacy's a big one. That's a big emphasis as to why I would prefer to go inside the clinic.” (Transgender female, 26 years old, 5 years on ART)
Impact of telemedicine on the interpersonal dynamic
Most PLHIV reported that their relationship and interpersonal dynamic with their clinician was unaffected by the use of telephone and/or video telemedicine. Those with long-term clinician relationships felt they had established comfort and trust, which continued when communicating over the telephone or video. These respondents tended to be older and in care for longer, but some recently-diagnosed PLHIV reported this as well, with participants sharing, “Well, for over the phone, I’m comfortable to be honest with you. I’m comfortable either way’cause I’ve been going there for so long, they’re like my family.” (Cisgender female, 47 years old, 28 years on ART) Another participant agreed and said, “[Doctor’s name] has really been amazing. [Doctor’s name] is perfect for telehealth, because I feel like I pick up the pieces where we left off in person, and it doesn't feel impersonal. It doesn't feel distant, it doesn't feel—it feels great actually.” (Cisgender male, 57 years old, 1 year on ART)
Many PLHIV said they had felt uncertain about telemedicine because they had never used it before—but, over time, they became more assured of telemedicine’s benefits for their HIV care and confident in their clinician’s ability to assess their needs as they would in-person, as illustrated by this participant: “I was real apprehensive at first, like, Hmm, am I really gonna get the care needed in my situation with these services? The answer was yes. We still were able to cover everything that’s affecting me and be able to do something about it just as if I was standing right there in the office.” (Cisgender male, 43 years old, 10 years on ART)
However, some PLHIV preferred the dynamic and connection offered by in-person visits, despite also feeling that telemedicine was an effective form of care, because “[telemedicine] is good in the sense of it works and it gets the job done. I like it. I think it's better than nothing, but I'm an in-person kind of guy. I like that connection.” (Cisgender male, 29 years old, 1 year on ART)
When discussing sensitive topics, such as sexually transmitted infections, relationship issues, or substance use, many PLHIV felt equally comfortable with telemedicine (either telephone or video) and in-person care due to their positive relationship with their clinician, sharing “I also trust [my clinician] to talk about [sensitive topics] over the phone and in person. It doesn’t matter.” (Transgender female, 60 years old, 26 years on ART) Others preferred telemedicine for these sensitive discussions because they found comfort in the physical distance, reasoning that “in person, you might not dare to speak about certain things. Over the phone it is easier to say things because the person is not there in front of you.” (Cisgender male, 58 years old, 14 years on ART) Other respondents said they liked discussing sensitive topics in person and would share more information in person as compared to by telemedicine, such as this participant who stated, “I like to talk to [my doctor] face to face when it comes to [my personal life and my relationship]… To be there and to have eye contact with her, she can see what else is going on with me… She can tell when I’m depressed…in person is better when I’m talking personal information to her.” (Cisgender female, 47 years old, 28 years on ART)
With regard to behavioral care and case management, PLHIV tended to feel positively about telephone or video telemedicine’s use for this care and enjoyed their experiences: “I love [telemedicine] for behavioral care. It's just fantastic…just authentically being comfortable being at home.” (Cisgender female, 57 years old, 3 years on ART) Another participant appreciated the flexibility of telemedicine for urgent issues: “I have case managers there that I can always call… They’re very good at helping me out, talking with me,’cause they know what’s going on with me, too… I had an issue about a month ago, and I really needed them, and they were able to step in and help me.” (Cisgender female, 47 years old, 28 years on ART)
PLHIV agreed that newly diagnosed individuals should have in-person visits and that the transition to telemedicine visits should occur only if and when PLHIV and their clinician are comfortable with this change in care, as expressed by one participant who felt that “For HIV care, at the beginning almost everything will have to be in person, because they have to be checking your [viral] load and all that month after month… Now after a year that I’ve been undetectable…[the doctor] can give you the option that the rest you need can be by telemedicine.” (Transgender female, 57 years old, 1 year on ART)
Interest in future telemedicine
All PLHIV were asked if they would like to continue having telephone and video telemedicine as an ongoing option for their HIV care, and all but one participant responded in the affirmative. Participants gave many reasons why they would like to incorporate telemedicine into their care long-term, including ease of completing appointments and reduced visits to the clinic, because “It's just easier to have a couple of [in-person] visits a year, and then the rest of the time, you can get care through telemedicine. It's easier for the doctor, easier for the patient.” (Cisgender female, 57 years old, 3 years on ART) Another participant shared, “I think [telemedicine is] the future, that’s what awaits us. I don’t think it will be a 100 percent replacement, but it would be very helpful.” (Cisgender male, 58 years old, 14 years on ART) PLHIV who spoke Spanish as their primary language exhibited similar interest in future telephone and video telemedicine as English-speaking patients, even if their clinician did not speak Spanish, given they felt comfortable with interpretation via telemedicine. One participant expressed, “I thought [telemedicine] was perfectly good, totally correct. Because in fact, the doctor asked the questions in English and her assistant translated them into Spanish, and that made me feel comfortable.” (Cisgender male, 58 years old, 11 years on ART)
When PHLIV were asked what their preferred balance of visit types would be, the most common response was half in-person and half telemedicine visits, mixed throughout the year: “If the patient comes six times in one year, schedule three and three and alternate in-person appointments with telemedicine appointments. That way the lab can be scheduled for the same day you go in person and the next visit the doctor usually just gives you the results and you don’t need to be there in person to obtain them.” (Cisgender male, 58 years old, 14 years on ART) The remaining PLHIV reported a diverse range of preferences about the balance between in-person and telemedicine. PLHIV who wanted telemedicine incorporated into their HIV care found this modality to be of best utility for visits to discuss lab results or for follow-up of a previous in-person visit, while in-person visits were necessary for doing lab work, collecting vital signs, and performing physical exams, such as one participant who preferred “to go in person when I need a blood test and when they give me the results they can just call me and that’s it. That would be ideal.” (Cisgender male, 45 years old, 9 years on ART)
Interest in video modality of telemedicine
Although few PHLIV in our study had experience with video telemedicine, some expressed a hypothetical preference for video over telephone visits reporting these would better mimic an in-person visit, reasoning that, “Although it’s virtual, you’re having a conversation with someone you’re watching, and it’s as if he’s in front of you. And so that gives you a little more comfort and confidence.” (Transgender female, 57 years old, 1 year on ART) A few PLHIV were not interested in utilizing video telemedicine as they felt that telephone visits were sufficient and perceived the training needed for video visits as being too burdensome. One participant reported being “… quite happy with a telephone call. I don’t want to FaceTime. A telephone call does the very same thing… It’s just not me. I’ve never done it, and I don’t intend to start.” (Cisgender male, 63 years old, 3 years on ART)
Results: clinical, programmatic, and policy stakeholders
Twenty-three individuals completed an interview, including ten clinicians (four of whom also had leadership roles), four case managers, and six individuals in clinic administrative roles. The remaining three individuals were policymakers involved in HIV and public health initiatives at the county level. Participants had worked in the HIV field for a range of one to thirty-one years and all had their first exposure to telemedicine for HIV care with the onset of the SARS-CoV-2 pandemic stay-at-home orders in March 2020. Two clinicians had prior experience with video telemedicine for other types of care. Participant characteristics are summarized in Table
3.
Table 3
Demographic Characteristics of Clinical, Programmatic, and Policy Stakeholders
Role, N (%) |
Clinician (physician or nurse) | 10 (43) | 7 (58) | 3 (38) |
Case manager | 4 (17) | 1 (9) | 3 (38) |
Clinic administrator | 6 (26) | 4 (33) | 2 (25) |
Policymaker | 3 (14) | N/A | N/A |
Years working in field of HIV, Median (IQR) | 10 (3–16) | 10 (2.5–19.5) | 10.5 (4.125–15.5) |
For clinicians and case managers: | Total (N = 14) | Clinic 1 (N = 8) | Clinic 2 (N = 6) |
Years providing telemedicine for HIV care, Median (IQR) | 1 (0.83–1.17) | 1 (1–1.21) | 1 (0.79–1.25) |
Experience providing telemedicine for non-HIV care, N (%)a b |
Yes | 2 (14) | 2 (25) | 0 (0) |
No | 11 (79) | 5 (63) | 6 (100) |
The following themes emerged from thematic analysis of clinical, programmatic, and policy stakeholder interviews, which are addressed in detail below: perceived impact of telemedicine on patient-level barriers to care; telemedicine implementation: challenges and solutions; telemedicine training; and beliefs about telemedicine.
Perceived impact of telemedicine on patient-level barriers to care
Many respondents mentioned that visit attendance was improved with telephone telemedicine, as one clinician stated: “Our no-show rate [is] actually dropping a little bit with telephone visits because people who typically would not have made it to clinic, we were able to have a visit by phone in their own space.” (Clinician, Clinic 2) This was seen as particularly salient for traditionally “hard-to-reach patients,” patients living far from the clinic, and those with complex travel routes to the clinic (generally involving longer commutes on public transportation or ride requests), because, “I think generally people miss less phone visit appointments just because it’s easier to access them, and we give them a couple tries. In-person…sometimes, people just don’t show up.” (Clinician, Clinic 1)
Most individuals agreed that the flexibility offered by telemedicine improved the clinics’ ability to efficiently and effectively reach patients. By meeting patient’s modality preferences (i.e., in-person versus telephone versus video visit), clinicians and case managers felt better able to provide more person-centered care, with one case manager stating, “I think anytime you provide different modes of communication, increase choice or possibilities, it increases access and increases client’s or patient choice and preference… it's overall been better [and] positive.” (Case manager, Clinic 1) Some individuals expressed that the increased flexibility of telemedicine could lead to improved health outcomes for PLHIV (including for other chronic conditions) since time saved with telemedicine could be spent taking care of other health needs, such as specialty appointments or cancer screening appointments, expressing that, “HIV care is not a one-size-fits-all [and] the more we can to be flexible about the options we give patients, the better off we will be in terms of seeing retention, suppression… maybe they will be more likely to go get their mammogram, or go get their colonoscopy.” (Clinician, Clinic 2)
However, many of these stakeholders voiced concern that PLHIV face significant barriers for accessing either telephone or video telemedicine visits, particularly patients who are unhoused, have lower income levels, or lack technological resources, with some stakeholders sharing that
“Many of our patients are low-income individuals. They don’t necessarily have a computer at home that has a camera, or they don’t have a smart [phone]—they may have a cell phone, but it’s one of the old flip phones.” (Clinic administrator, Clinic 1) One clinician stated that
“Fifty percent of my patients just flat out refuse any telemedicine, but most of those patients, again, are either homeless, in transitional housing of some form [or] they don’t have an income, so they may not have a reliable phone.” (Clinician, Clinic 1) Many of these patients were perceived to also have insufficient technological literacy to participate in video visits. Telephone visits were generally the default modality for telemedicine (Table
4) due to clinic staff
“trying to still figure out how we're gonna do [video appointments] with a lot of our patients 'cause a lot of them are not tech savvy. Right now, we're just doing the phones.” (Case manager, Clinic 2) One clinic administrator expressed that
“We did more telephonic visits than we did video visits because it was easier for a patient, even with an old flip phone, to actually call in and talk to a provider as opposed to actually having to do a video visit where they had to see the provider.” (Clinic administrator, Clinic 1)
Table 4
Current Use of HIV Care Telemedicine and In-Person Visits by Clinicians and Case Managers
Current mode of telemedicine |
Telephone only | 9 (64) | 3 (37) | 6 (100) |
Video only | 0 (0) | 0 (0) | 0 (0) |
Both telephone and video | 5 (36) | 5 (63) | 0 (0) |
Percent of HIV visits that are telemedicinea |
< 20 | 2 (14) | 1 (12) | 1 (17) |
20–29 | 4 (29) | 3 (37) | 1 (17) |
30–39 | 3 (21) | 1 (12) | 2 (33) |
40–49 | 0 (0) | 0 (0) | 0 (0) |
50 or more | 3 (21) | 2 (25) | 1 (17) |
Preferred minimum number of in-person visits annuallyb |
0 | 2 (14) | 2 (25) | 0 (0) |
1 | 4 (29) | 2 (25) | 2 (33) |
2 | 6 (43) | 2 (25) | 4 (67) |
3 or more | 1 (7) | 1 (12) | 0 (0) |
Clinicians who required medical interpretation in order to have visits with monolingual Spanish-speaking PLHIV felt that interpretation done over telemedicine (either telephone or video) added additional complexity to the visit and resulted in a preference for in-person visits, with one clinician sharing, “If I have to use a translator through the phone, it's just not the same interaction. Sometimes they like coming in, so even if I need a translator, I'm there, they can see my body language, et cetera.” (Clinician, Clinic 2) The clinicians who were fluent in Spanish and did not require medical interpretation, however, found that Spanish-speaking PLHIV did not have a strong preference for in-person over either telephone or video telemedicine visits, affirming that, “Language wise, I don't really get a sense that really pushes people to have one type of visit over another… I can have a lot of my visit types in Spanish… If a phone visit interaction truly is easier for [the patient] versus a face-to-face visit, they'll let me know.” (Clinician, Clinic 1)
Telemedicine implementation: challenges and solutions
While the adaptability of telemedicine created advantages for PLHIV, the abrupt need to initiate telemedicine due to SARS-CoV-2 exacerbated the implementation challenges faced by clinics. These challenges included creating workflows to incorporate telephone and video telemedicine into visit protocols and adding new responsibilities to staff roles, because “Telehealth requires an added level of pre- and post-visit planning… We need to do the same things in the virtual world that we've been doing in the physical world, which is having a staff member available to room the patient, but they take more time and more coordination, and there's more opportunity for delay.” (Policymaker) One clinician shared that “It’s just been cumbersome to tie in the medical assistants [MAs] into those video visits too where, in a normal first face-to-face visit, they would usually be seeing the patient, do the vital signs, checking them in and doing their chief complaint, updating their medication list, et cetera.” (Clinician, Clinic 1)
Balancing schedules that included both in-person and telemedicine visits (either telephone or video) was also challenging for clinic staff, but many found solutions over time, as discussed by one case manager who felt that “It was challenging in the beginning because we were learning as we go, and organizing the schedule was a work in progress… We have gotten to this stage where we would dedicate the first portion of the clinic time for in-person visits, and then the remainder of the clinic time would be for telemedicine visits.” (Case manager, Clinic 2) Although both facilities incorporated phone visits quickly and with overall success, respondents cited barriers with video visits due to difficulties with video visit platforms and lack of staff buy-in, with one clinic administrator stating, “We've actually switched multiple times and tried different [video visit] platforms that would be easier to use for patients and easier to use for staff… The third interface was the easiest, but… it was harder to get the buy-in because at this point, they had gotten used to doing the phone calls.” (Clinic administrator, Clinic 1)
Some Clinic 1 staff also perceived limited leadership buy-in to telemedicine, mentioning “Our main medical leadership wasn't pushing [telemedicine]… [and] was also leery about it and not really 100 percent about it and, in my honest opinion, probably didn't really even wanna do it.” (Clinic administrator, Clinic 1) In contrast, Clinic 2 staff stated significant support during the telemedicine implementation process, where “The leadership has been onboard as well… Me personally, I didn’t really feel that there [was] pushback or a deer-in-the-headlights scenario… In fact, there are even non-clinical people who wanted to know and learn how can they be of help in promoting telehealth. I think this was really like a—it was a good team effort.” (Clinic administrator, Clinic 2)
Telemedicine training
Clinicians and case managers reported variation in their telemedicine training. A few completed an initial training that they felt was adequate for their needs, but many shared that they had never been trained on how to use telemedicine (either telephone or video) nor how to incorporate it into their workflow. Nonetheless, individuals generally felt like they could access information and additional training if needed, with one clinician sharing, “I know that there were several afternoons blocked where they did training with the electronic medical record. I’m not in clinic every day so I wasn’t there for one of the trainings, so I didn’t do it… I probably could be more aggressive about seeking out training on the video.” (Clinician, Clinic 2)
Even with no additional training, most individuals were confident in their capacity to provide quality care to their patients over telephone visits. Some also shared that, as they did more telephone visits over time, their skills and comfort increased: “In the beginning, [telemedicine] was pretty daunting, but I think over the first few months, both my patients and I got more comfortable with it. I think it's actually been the preferred method of interaction between more and more of my patients.” (Clinician, Clinic 1)
Beliefs about telemedicine
Individuals interviewed exhibited diverse opinions about telemedicine for HIV care. Many had positive attitudes and liked using telemedicine for routine visits, such as one clinician who stated that "...[it] was very much needed that we started expanding doing [telemedicine], and it’s becoming more accepted. It’s something we can do as a more routine type of visit. I’m very satisfied that we have expanded that type of care.” (Clinician, Clinic 1) In some cases, this positive attitude was based, in part, on their own use of telemedicine for their personal health, with one clinic administrator sharing, “I’ve had telehealth visits with my provider, and it’s actually cool. I’d almost prefer it. That way, I don’t have to get up and go into the clinic.” (Clinic administrator, Clinic 1) In contrast, some interviewees had negative views of telemedicine (both telephone and video) for HIV care, citing reasons such as patients being generally unhappy with the quality of care provided over telemedicine and preferring in-person visits. One clinician expressed, “I might have already revealed my bias… I hate it. I hate it because I don't like telehealth. I hate it because we end up with wasted time slots…'cause patients would rather come in person than do telehealth.” (Clinician, Clinic 1)
With regard to telemedicine use for behavioral care and case management purposes, clinicians found this to be generally suitable for PLHIV. They reported that, for mental health, people “seem to do quite well with telehealth [and] it seems to be quite popular for the providers and the patients.” (Clinician, Clinic 1) This was also true for case management: “Folks that require lots of care and continuous follow up really benefit from being able to access us through technology.” (Case manager, Clinic 1)
Clinical, programmatic, and policy stakeholders agreed that in-person care for PLHIV who were newly diagnosed was and should remain the norm, as detailed by one clinician who stated, “It’s pretty unusual for us to do phone visit for [new diagnoses]… I think all those nonverbal cues are really important, especially with a new diagnosis, having a discussion, education about what that means, and giving support to the patient, getting their history. I think [in-person care] establishes that rapport, which for a new HIV diagnosis, that’s very, very important to make sure they stay engaged in care.” (Clinician, Clinic 1)