Like other providers, the VA saw a large, pandemic-related increase in virtual visits. In 2019, 27% of visits were virtual compared with 64% in 2020.
The World Health Organization has long promoted simpler access and reducing time spent in healthcare facilities for people with HIV, and The Journal of the International AIDS Society created a supplement issue to help understand how care for people with HIV changed has during the COVID-19 pandemic and whether less time would be detrimental for patients.
One of the studies published in that supplemental focused about 28,000 people with HIV who get care from the Department of Veterans Affairs, which few people realize is the largest provider of HIV care in the United States.
Like other providers, the VA saw a large, pandemic-related increase in virtual visits. In 2019, 27% of visits were virtual compared to 64% in 2020. Interestingly, the vast majority of the virtual visits were conducted by phone: Of the virtual visits, 99% and 92% were by telephone (vs. video) in 2019 and 2020, respectively.
Of the patients whose viral load was measured, 92% had suppressed levels in 2019 and 91% in 2020. However, the study showed that the proportion of patients who had a viral load measurement dipped from 82% in 2019 to 74% in 2020
“The findings showed that the quality of VA HIV healthcare was maintained during the pandemic,” says Kathleen McGinnis with the U.S. Department of Veterans Affairs, the lead researcher on the study. “The VA substantially increased the use of virtual (mostly telephone) visits and longer refills (mostly by mail) for antiretroviral therapy medication. ART (antiretroviral) coverage was maintained and percent with VL (viral load) suppression (among those with VL measured) was similar during and before the pandemic.”
“With the drastic reduction of in-person services for non-emergency health issues, virtual visits were the best way to maintain patient engagement in HIV primary care,” observes McGinnis.
Prescription policy adjustments in 2020 led to more people getting prescriptions for a 90-day supply of the antiretroviral medications that suppress HIV and keep people with the infection healthy. In 2020 just over half (51%) of refills 90 days or longer compared with 39% in 2019. Even though there was a lower number of refills in 2020 compared to 2019, because average prescription length was longer, coverage was similar for 2019 and 2020, ranging from 76% to 80% for all months except for March 2019, which was at 72%.
McGinnis and her colleagues used data from the Veterans Aging Cohort Study to conduct their research
It’s widely believed that virtual visits will continue to be more common than they were prior to the pandemic, both in general and particularly among those who have mobility and/or transportation issues.
“The findings could have long-term implications for more efficient HIV care in general, perhaps involving longer prescription fills, greater use of mail in prescription services, fewer in-person visits and less frequent VL tests,” McGinnis says.
Still, she notes more research is needed to determine whether there are other, as yet unmeasured, adverse effects such as decreased adherence to prescription medications for other diseases.