Open AccessEvaluation of the integration of telehealth into the same‐day antiretroviral therapy initiation service in Bangkok, Thailand in response to COVID‐19: a mixed‐method analysis of real‐world data
Author(s) -
Amatavete Sorawit,
Lujinta Sita,
Teeratakulpisarn Nipat,
Thitipatarakorn Supanat,
Seekaew Pich,
Hanaree Chonticha,
Sripanjakun Jirayuth,
Prabjuntuek Chotika,
Suwannarat Lertkwan,
Phattanathawornkool Thana,
Photisan Nuttawoot,
Suriwong Sujittra,
Avery Matthew,
Mills Stephen,
Phanuphak Praphan,
Phanuphak Nittaya,
Ramautarsing Reshmie A.
Publication year - 2021
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25816
Subject(s) - medicine , telehealth , thematic analysis , pandemic , referral , family medicine , antiretroviral therapy , covid-19 , telemedicine , viral load , medical emergency , health care , human immunodeficiency virus (hiv) , qualitative research , disease , social science , sociology , infectious disease (medical specialty) , economics , economic growth
Same‐day antiretroviral therapy (SDART) initiation has been implemented at the Thai Red Cross Anonymous Clinic (TRCAC) in Bangkok, Thailand, since 2017. HIV‐positive, antiretroviral therapy (ART)‐naïve clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the first wave of the coronavirus disease 2019 (COVID‐19) outbreak in March 2020, telehealth follow‐up was established to comply with COVID‐19 preventive measures and allow service continuation. Here, we evaluate its implementation. Methods Pre‐COVID‐19 (until February 2020) clients who initiated SDART received a 2‐week ART supply and returned to the clinic for evaluation before being referred to long‐term ART maintenance facilities. If no adverse events (AEs) occurred, another 8‐week ART supply was provided while referral was arranged. During the first wave of COVID‐19 (March–May 2020), clients received a 4‐week ART supply and the option of conducting follow‐up consultation and physical examination via video call. Clients with severe AEs were required to return to TRCAC; those without received another 6‐week ART supply by courier to bridge transition to long‐term facilities. This adaptation continued post‐first wave (May–August 2020). Routine service data were analysed using data from March to August 2019 for the pre‐COVID‐19 period. Interviews and thematic analysis were conducted to understand experiences of clients and providers, and gain feedback for service improvement. Results Of 922, 183 and 321 eligible clients from the three periods, SDART reach [89.9%, 96.2% and 92.2% ( p = 0.018)] and ART initiation rates [88.1%, 90.9% and 94.9% ( p <0.001)] were high. ART uptake, time to ART initiation and rates of follow‐up completion improved over time. After the integration, 35.3% received the telehealth follow‐up. The rates of successful referral to a long‐term facility (91.8% vs. 95.3%, p = 0.535) and retention in care at months 3 (97.5% vs. 98.0%, p = 0.963) and 6 (94.1% vs. 98.4%, p = 0.148) were comparable for those receiving in‐person and telehealth follow‐up. Six clients and nine providers were interviewed; six themes on service experience and feedback were identified. Conclusions Telehealth follow‐up with ART delivery for SDART clients is a feasible option to differentiate ART initiation services at TRCAC, which led to its incorporation into routine service.