Pivoting to Video Telehealth for Delivery of HIV Care During COVID-19: A Brief Report.

Abstract

Background: The rapid spread of the SARS-CoV-2 pandemic obstructed human subjects research, including our own randomized hybrid type 2 effectiveness-implementation trial comparing multidisciplinary HIV care delivered by video telehealth to home (VTH) versus in-person delivery. Methods: Given the Veteran Health Administration's extensive telehealth infrastructure and our team's expertise in personalized implementation of virtual treatments (PIVOT), we shifted our focus to meet the immediate needs of our primary study site (implementation). Our implementation team began training the interdisciplinary infectious diseases clinical team in VTH after declaration of the pandemic in March 2020. We pivoted from a randomized clinical trial recruitment and supported modifications in clinic processes by introducing patients to VTH through personalized telephone calls and mailed brochures to inform them of telehealth options during the pandemic. Adaptations were made to provider locations, with some providers delivering care remotely from home and others delivering virtual care from the clinic. We also modified the external and internal facilitator roles to allow external facilitators to provide one-on-one training, troubleshooting assistance, and delivery of necessary equipment. Results: Within 6 weeks of the emergency declaration of the pandemic, 100% of providers (n = 27) had conducted at least one appointment, with 24.1% (n = 124) of unique patients using VTH. Despite challenges, we capitalized on temporary mandates to assist providers in delivering care virtually. Given our successes, we encourage researchers to be flexible and seek alternative approaches to preserve research efforts in extenuating circumstances. RCT registration: NCT04055207 at clinicaltrials.gov.