From Crisis to Connection: HIV Care Telehealth as an Antidote to Loneliness During the COVID-19 Stay-at-Home Era.

Abstract

This study investigated the impact of COVID-19-related disruptions to healthcare systems on engagement with HIV care among people enrolled in treatment at a university hospital's infectious disease (ID) clinic. Clinical outcome data from January 2019 to December 2020 were analyzed, and in-depth, semi-structured interviews were conducted from March 2021 to October 2021 with 20 participants enrolled in HIV care at the clinic. Informal interviews were conducted with seven people who work directly with clients at the ID clinic and similar settings to inform the refinement of the interview guide and support the triangulation of findings. Bivariate analyses of clinical outcome data were completed for 2019 and 2020, while qualitative data were analyzed using deductive thematic analysis. Demographic characteristics were similar across the 2019 and 2020 clinical cohorts, with median ages of 44.6 (IQR: 32.2, 55.4) and 45.1 (IQR: 32.9, 56.1), respectively. Most of the population identified as Black and cisgender men in both years. There were unexpected improvements in clinical outcomes. Retention rates increased from 72.5% (n = 5355/7373) in 2019 to 73.6% (n = 4982/6769; p < 0.01) in 2020. Additionally, median duration between visits decreased significantly from 98 days (63, 126) in 2019 and 91 (56, 98) days in 2020 (p < 0.01). Qualitative interviews suggest that, during the 2020 stay-at-home period, the clinic's integrated HIV care model played a significant role in improving clinical outcomes. Participants who engaged actively in the integrated HIV care model were encouraged to advocate for their own health and pursue personal goals and life projects beyond clinical care. Their involvement in HIV care and positive relationships with care teams led to two major outcomes. First, strong ties to the clinic staff fostered participants' trust in health information and empowered them to actively seek out health knowledge, which together motivated their early adoption of COVID-19 precautions. Paradoxically, adhering to COVID-19 precautions exacerbated their feelings of isolation, anxiety, substance use, and other psychological and physical co-morbidities. Second, participants mitigated these feelings of isolation by maintaining regular HIV care appointments-efforts that were supported by the expanded availability of telehealth during this period. Finally, despite initial negative feelings about telehealth, participants viewed their HIV appointments as valuable opportunities for social connections.