Telehealth provides a viable alternative to early identification of HIV continuing care, based on data from 28 newly diagnosed adults with HIV.
The shortage of HIV-trained healthcare providers is well-known and is expected to worsen in the United States, said Rosemary Donnelly, MSN, ANP-BC, ACRN, AAHIVS, of Q Care Plus, a provider of telehealth services for preexposure prophylaxis (PrEP) and HIV care in multiple states. Strategies to address the shortage, notably the use of telehealth, are being investigated, she said.
"It was important to examine the outcomes of patients who tested positive/reactive for HIV during PrEP initiation or restarting of PrEP, given the known benefits of rapid antiretroviral therapy (ART) and the unique opportunity to provide rapid ART via telehealth," Donnelly said in an interview.
Several previous randomized trials have shown decreased morbidity and mortality for individuals living with HIV with high CD4 counts who received ART immediately compared with those with delayed treatment, she said.
In the study, presented at the annual meeting of the Association of Nurses in AIDS Care, Donnelly and colleagues reviewed data from 28 individuals with reactive or preliminary positive HIV results in their electronic medical records via telehealth between January 1, 2024, and April 6, 2024. The average age of the participants was 31.4 years. The 28 individuals in the study were male at birth; 27 identified as cisgender male and one identified as genderqueer. Regionally, 82% of the patients with reactive HIV results were from the South, a region that accounted for 52% of overall HIV diagnoses in the United States in 2022, the researchers noted.
Prior use of sexually transmitted infection (STI) and HIV prevention practices varied, but 75% of the participants reported using condoms in less than half of sexual encounters, and 71% reported never taking HIV prophylaxis (PrEP). Slightly less than half (46%) of the participants reported previous STIs.
Nine participants (ie, approximately one third) reported that they had had their last HIV test 1-6 months ago, four reported 6-12 months, 10 reported 1-2 years, four reported more than 2 years, and one had never been tested. Only one participant was diagnosed with AIDS at the time of HIV diagnosis, with a CD4 count of 188 cells/µL, the authors noted, for an AIDS rate of 4.5% that was much lower than the US average of approximately 21%.
Despite the study's small sample size, "we were happily surprised that patients were identified early in their HIV infection, with only one patient diagnosed with AIDS (4.5%) and 33% reporting their last HIV test was less than 6 months before the reactive test result," Donnelly told Medscape Medical News. "We are also surprised by the high false-positivity rate of HIV tests during this period; 11 out of 39 reactive HIV test results (28%) were false-positive results," she said. "We did not formally review the reasons for this high rate but attribute it to recent COVID infections for some of the patients," she said.
The findings were limited by the small size and lack of coordination with the local department of health to track three individuals lost to care, the researchers noted. However, overall, 89% of patients were linked to care locally or remained in telehealth for HIV care, which supports the use of telehealth as a viable alternative to early identification of HIV and ongoing treatment, Donnelly told Medscape Medical News.
Looking ahead, "we plan to review the linkage to care and rapid ART rates for patients receiving HIV positive test results via telehealth," Donnelly said. "We would like to reach other Ending the HIV Epidemic (EHE) priority populations, such as minority cisgender and transgender women," she added.
"It is imperative that people newly diagnosed with HIV start taking antiretroviral medications as soon as possible," said Rachel K. Wion, PhD, RN, assistant professor at Indiana University School of Nursing, Indianapolis, in an interview.
"Delays in treatment initiation have been associated with increased morbidity and mortality, including worse long-term health outcomes, while immediate initiation of ART has been linked to improved health outcomes, faster viral suppression, and increased retention in care," said Wion, who was not involved in the current study.
Telehealth may be a viable means for providing consultation and rapid-start ART. This can possibly be initiated through identification of people newly diagnosed with HIV through TelePrEP. TelePrEP services provide remote consultation, HIV testing, and delivery of HIV PrEP medications.
Although the sample was small, the implication of this exploratory, descriptive study is that TelePrEP may be an acceptable venue for diagnosis and rapid-start ART initiation in people newly diagnosed with HIV, Wion told Medscape Medical News.
"The next step should be to conduct a study with a much larger sample using multiple TelePReP services," she said.