Visit trends and factors associated with telemedicine uptake among persons with HIV during the COVID-19 pandemic

Wood, Brian R; Lan, Kristine F; Tao, Yuan; Mose, Eric Y; Aas, Erin; Budak, Jehan Z; Dhanireddy, Shireesha; Kim, H Nina

BACKGROUND: In response to the SARS-CoV-2 pandemic, clinicians in outpatient HIV practices began to routinely offer telemedicine (video and/or phone visits) to replace in-person appointments. Video visits are preferred over phone visits but determinants of video visit uptake in HIV care settings have not been well described. METHODS: Trends in type of encounter (face-to-face, video, and phone) before and during the pandemic were reviewed for persons with HIV (PWH) at an urban, academic, outpatient HIV clinic in Seattle, WA. Logistic regression was used to assess factors associated with video visit use including sociodemographic characteristics (age, race, ethnicity, language, insurance status, housing status) and electronic patient portal login. RESULTS: After an initial increase in video visits to 30% of all completed encounters, the proportion declined and plateaued at approximately 10%. A substantial proportion of face-to-face visits were replaced by phone visits (approximately 50% of all visits were by phone early in the pandemic, now stable at 10 to 20%). Logistic regression demonstrated that older age (>50 or >65 years old compared to 18 to 35 years old), Black, Asian, or Pacific Islander race (compared to White race), and Medicaid insurance (compared to private insurance) were significantly associated with never completing a video visit, whereas history of patient portal login was significantly associated with completing a video visit. CONCLUSIONS: Since the pandemic began, an unexpectedly high proportion of telemedicine visits have been by phone instead of video. Several social determinants of health and patient portal usage are associated with video visit uptake.