Skip to main content

Advertisement

SpringerLink
Log in

Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020–December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

EMR:

Electronic medical record

NQF:

National Quality Forum

PWH:

Persons with HIV

References

  1. Johns Hopkins University. The center for systems science and engineering. COVID-19 dashboard. 2021 [cited 2022 Nov 28]. Available from: https://www.coronavirus.jhu.edu/map.html.

  2. Ohl M, et al. Mixed-methods evaluation of a telehealth collaborative care program for persons with HIV infection in a rural setting. J Gen Intern Med. 2013;28(9):1165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kane CK, Gillis K. The use of telemedicine by physicians: still the exception rather than the rule. Health Aff (Millwood). 2018;37(12):1923–30.

    Article  PubMed  Google Scholar 

  4. Appropriations, House Budget, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, in Public Law No: 116-123 (03/06/2020), H.R.t.t.C.-. Congress, editor. 2020.

  5. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Updated national survey trends in telehealth utilization and modality (2021–2022). 2023 Feb 7. Available from: https://aspe.hhs.gov/reports/updated-hps-telehealth-analysis-2021-2022.

  6. Young JD, et al. Infectious Diseases Society of America position statement on telehealth and telemedicine as applied to the practice of infectious diseases. Clin Infect Dis. 2019;68(9):1437–43.

    Article  PubMed  Google Scholar 

  7. Centers for Disease Control and Prevention. Telehealth and telemedicine. 2023 Feb 7. Available from: https://www.cdc.gov/phlp/publications/topic/telehealth.html.

  8. Telehealth.HHS.GOV. 2023 Feb 7. Available from: https://telehealth.hhs.gov/.

  9. Nitiema P. Telehealth before and during the COVID-19 pandemic: analysis of health care workers’ opinions. J Med Internet Res. 2022;24(2): e29519.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miller MJ, et al. Patient experience after modifying visit delivery during the COVID-19 pandemic. Am J Manag Care. 2021;27(2):e54–63.

    PubMed  Google Scholar 

  11. Fadul N, et al. A Midwestern academic HIV clinic operation during the COVID-19 pandemic: implementation strategy and preliminary outcomes. J Int Assoc Provid AIDS Care. 2021;20:23259582211041424.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mayer KH, et al. Rapid migration to telemedicine in a Boston community health center is associated with maintenance of effective engagement in HIV care. Open Forum Infect Dis. 2020;7(Suppl 1):S337–8.

    Article  PubMed Central  Google Scholar 

  13. Harsono D, et al. Experiences with telemedicine for HIV care during the COVID-19 pandemic: a mixed-methods study. AIDS Behav. 2022;26(6):2099–111.

    Article  PubMed  PubMed Central  Google Scholar 

  14. National Quality Forum. 2021. Rural telehealth and healthcare system readiness measurement framework. Washington, DC. Available at: https://www.qualityforum.org/Publications/2021/11/Rural_Telehealth_and_Healthcare_System_Readiness_Measurement_Framework_-_Final_Report.aspx.

  15. Greenberg AE, et al. Development of a large urban longitudinal HIV clinical cohort using a web-based platform to merge electronically and manually abstracted data from disparate medical record systems: technical challenges and innovative solutions. J Am Med Inform Assoc. 2016;23(3):635–43.

    Article  PubMed  Google Scholar 

  16. Harris PA, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  17. Harris PA, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kaiser Permanente. KP Research Bank COVID-19 surveys. 2020. 2023 Feb 9. Available from: https://researchbank.kaiserpermanente.org/wp-content/uploads/2021/05/KPRB-COVID-19-Survey_-summary.pdf.

  19. Wilbourn B, et al. Characterization of HIV risk behaviors and clusters using HIV-transmission cluster engine among a cohort of persons living with HIV in Washington, DC. AIDS Res Hum Retrovir. 2021;37(9):706–15.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stanford. COVID19 interview items for vulnerable populations. 2020. 2023 Feb 9. Available from: https://clelandcm.github.io/COVID19-Interview-Items/COVID-Items.html#stanford.

  21. Behar-Zusman V, Chavez JV, Gattamorta K. Developing a measure of the impact of COVID-19 social distancing on household conflict and cohesion. Fam Process. 2020;59(3):1045–59 (9 Feb 2023).

  22. ATN. COVID Questionnaire Draft. 2020. 2023 Feb 9. Available from: https://clelandcm.github.io/COVID19-Interview-Items/COVID-Items.html#atn.

  23. CDC. Human infection with 2019 novel coronavirus case report form interviewer information case classification and identification. 2023 Feb 9. Available from: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf.

  24. City University of New York Institute for Implementation Science in Population Health. Baseline Questionnaire for the Communities, Households and SARS/COV-2 Epidemiology (CHASE) COVID Study. March 31, 2020. Available from: https://cunyisph.org/wp-content/uploads/CHASE-COVID_baseline_V2.1.pdf.

  25. Kalichman S. Kalichman Covid-19 Assessment. 2020. Available from: https://clelandcm.github.io/COVID19-Interview-Items/COVID-Items.html#kalichman-covid-19-assessment.

  26. Creswell JW, et al. National Institutes of Health. 2011. Best practices for mixed methods research in the health sciences. Bethesda. Available at: https://obssr.od.nih.gov/sites/obssr/files/Best_Practices_for_Mixed_Methods_Research.

  27. ATLAS.ti Scientific Software Development GmbH [ATLAS.ti 22 Windows]. 2022.

  28. Smaling A. Varieties of methodological intersubjectivity—the relations with qualitative and quantitative research, and with objectivity. Qual Quant. 1992;26:169–80.

    Article  Google Scholar 

  29. Labisi T, et al. HIV care meets telehealth: a review of successes, disparities, and unresolved challenges. Curr HIV/AIDS Rep. 2022;19(5):446–53.

    PubMed  PubMed Central  Google Scholar 

  30. Ennis N, Armas L, Butame S, Joshi H. Factors impacting video telehealth appointment completion during COVID-19 pandemic among people living with HIV in a community-based health system. AIDS Behav. 2021;6(2):407–14.

    Article  PubMed  Google Scholar 

  31. Friedman EE, Devlin SA, Gilson SF, Ridgway JP. Age and racial disparities in telehealth use among people with HIV during the COVID-19 pandemic. AIDS Behav. 2022;26(8):2686–91.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Auchus IC, et al. Transitioning to telehealth during the COVID-19 pandemic: patient perspectives and attendance at an HIV clinic in San Francisco. AIDS Patient Care STDS. 2021;35(7):249–54.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Grove M, Brown LB, Knudsen HK, Martin EG, Garner BR. Employing telehealth within HIV care: advantages, challenges, and recommendations. AIDS. 2021;35(8):1328–30.

    Article  PubMed  Google Scholar 

  34. Smith E, Badowski ME. Telemedicine for HIV care: current status and future prospects. HIV AIDS (Auckl). 2021;13:651–6.

    CAS  PubMed  Google Scholar 

  35. Budak JZ, et al. The impact of COVID-19 on HIV care provided via telemedicine-past, present, and future. Curr HIV/AIDS Rep. 2021;18(2):98–104.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Spears CE, et al. Intersecting epidemics: the impact of coronavirus disease 2019 on the HIV prevention and care continua in the United States. AIDS. 2022;36(13):1749–59.

    Article  CAS  PubMed  Google Scholar 

  37. Dandachi D, et al. Integration of telehealth services in the healthcare system: with emphasis on the experience of patients living with HIV. J Investig Med. 2019;67(5):815–20.

    Article  PubMed  Google Scholar 

  38. Bouabida K, et al. Healthcare professional perspectives on the use of remote patient-monitoring platforms during the COVID-19 pandemic: a cross-sectional study. J Pers Med. 2022;12(4):529.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary care guidance for persons with human immunodeficiency virus: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021;73(11):e3572–605.

    Article  PubMed  Google Scholar 

  40. Patel MC, Young JD. Delivering HIV subspecialty care in prisons utilizing telemedicine. Dis Mon. 2014;60(5):196–200.

    Article  PubMed  Google Scholar 

  41. Castaño PM, Stockwell MS, Malbon KM. Using digital technologies to improve treatment adherence. Clin Obstet Gynecol. 2013;56(3):434–45.

    Article  PubMed  Google Scholar 

  42. Koay WLA, et al. Brief report: supporting access to HIV care for children and youth during the COVID-19 pandemic with telemedicine and rideshare. J Acquir Immune Defic Syndr. 2021;88(4):384–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Campbell BR, et al. PositiveLinks and the COVID-19 response: importance of low-barrier messaging for PLWH in non-urban Virginia in a crisis. AIDS Behav. 2021;25(11):3519–27.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Collins LF, et al. The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings. AIDS. 2021;35(2):337–41.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Data in this manuscript were collected by the DC Cohort Study Group with investigators and research staff located at: Children’s National Hospital Pediatric clinic (Natella Rakhmanina); the Senior Deputy Director of the DC Department of Health HAHSTA (Clover Barnes); Family and Medical Counseling Service (Angela Wood); Georgetown University (Princy Kumar); The George Washington University Biostatistics Center (Tsedenia Bezabeh, Vinay Bhandaru, Asare Buahin, Nisha Grover, Lisa Mele, Susan Reamer, Alla Sapozhnikova, Greg Strylewicz, and Marinella Temprosa); The George Washington University Department of Epidemiology (Shannon Barth, Morgan Byrne, Amanda Castel, Alan Greenberg, Shannon Hammerlund, Olivia Kirby, Paige Kulie, Anne Monroe, Lauren O’Connor, James Peterson, Bianca Stewart, and Mark Storey); The George Washington University Medical Faculty Associates (Jose Lucar); Howard University Adult Infectious Disease Clinic (Jhansi L. Gajjala) and Pediatric Clinic (Sohail Rana); Kaiser Permanente Mid-Atlantic States (Michael Horberg); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Duane Taylor); Washington Health Institute, formerly Providence Hospital (Jose Bordon); Unity Health Care (Gebeyehu Teferi); Veterans Affairs Medical Center (Debra Benator, Rachel Denyer); Washington Hospital Center (Adam Klein); and Whitman-Walker Institute (Stephen Abbott). The DC Cohort and COVID-19 supplement were funded by the National Institute of Allergy and Infectious Diseases, 1R24AI152598-01.

Funding

The DC Cohort and COVID-19 supplement were funded by the National Institute of Allergy and Infectious Diseases, 1R24AI152598-01. This research is funded by NIH Grant R24AI152598-01.

Author information

Authors and Affiliations

  1. Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA

    Shannon K. Barth, Anne K. Monroe, Alan E. Greenberg & Amanda D. Castel

  2. Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA

    Kacie J. Saulters

  3. Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA

    Gayle P. Balba

  4. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA

    Michael A. Horberg

  5. Georgetown University School of Medicine, Washington, DC, USA

    Princy N. Kumar

Authors
  1. Shannon K. Barth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kacie J. Saulters
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gayle P. Balba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne K. Monroe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael A. Horberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Princy N. Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alan E. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amanda D. Castel
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the DC Cohort Executive Committee

Corresponding author

Correspondence to Shannon K. Barth.

Ethics declarations

Competing Interests

Dr Barth: none; Dr Saulters: Alliance for Academic Internal Medicine, American College of Physicians 2021–2022, Paid to institution; Magnolia Regional Medical Center, Corinth MS 2020 and 2021, payment made to individual; Support for travel to Alliance for Academic Internal Medicine 2022, payment made to individual; Dr. Balba: Gilead, GlaxoSmithKline personal stocks; Dr. Kumar: Consulting fees from ViiV/GSK, Merck, Thera Technology, Johnson and Johnson, paid to individual; personal stocks in Pfizer, Gilead, Merck, Moderna, Johnson and Johnson; Dr. Greenberg: Invited speaker, Davidson College, paid to individual; DSMB/AB UW CFAR EAB (all unrelated), JHU CFAR EAB, ERC CFAR EAB, paid to individual; Dr. Castel: Research award from Gilead Sciences, Funding from National Institutes of Health, paid to individual; NIH NIDA Clinical Trials Network; personal stocks in Pfizer, Viatris, Inc.; Receipt of medications through Gilead Sciences grant as mentioned above, paid to institution.

Ethical Approval

The survey was approved by the George Washington University Institutional Review Board (IRB) and specific sites’ IRBs (Washington DC Department of Veterans Affairs, Washington Hospital Center, Children’s National Medical Center).

Informed Consent

Electronic informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 45 kb)

Supplementary file2 (DOCX 144 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barth, S.K., Saulters, K.J., Balba, G.P. et al. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 28, 912–923 (2024). https://doi.org/10.1007/s10461-023-04198-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04198-7

Keywords

Search

Navigation