Telemedicine virologic and immunologic outcomes in people living with HIV (PLWH) in a correctional setting during the SARS-CoV-2 pandemic

Abstract

Abstract Background It is known that SARS-CoV-2 infection increases the risk of severe illness in patients who are immunocompromised as compared to the general public. To combat this issue, telemedicine was utilized to combat the issue of general access to care to decrease the risk of exposure of SARS-CoV-2 infection in various settings. However, there is very little data on adequate continuity of care (COC) and sustainability of telehealth throughout the SARS-CoV-2 pandemic. There is even less data on the effects of the SARS-CoV-2 pandemic in special populations, such as people living with human immunodeficiency virus (PLWH) who reside in the correctional setting. The purpose of this study was to investigate rates of HIV virologic suppression (VS) and the sustainability of telemedicine throughout the SARS-CoV-2 pandemic. Methods This was a retrospective, pre-post cohort study of PLWH who received antiretroviral therapy (ART) within Illinois Department of Corrections (IDOC)/University of Illinois at Chicago telemedicine clinic between March 2019– March 2021. Patients who were released from IDOC or reincarcerated during the study period were excluded. The primary endpoint compared the rate of HIV VS pre-, peri-, and post-SARS-CoV-2 restrictions. Secondary endpoints included change in immunologic function pre-, peri-, and post-SARS-CoV-2 restrictions, incidence of SARS-CoV-2 infection, number of hospitalizations, development of virologic failure, and change in ART post-restriction. Other factors known to influence COC were also collected. Results Of 320 patients screened, 225 were included. The majority were Black males (73.7%) where 95.1% had a CD4 T-cell count > 200 cells/mm3 at baseline. Approximately 88% of patients were on a single tablet regimen, with most receiving bictegravir/emtricitabine/tenofovir alafenamide (39.1%). Factors associated with disruption of COC included missed scheduled appointments (62.6%) and non-adherence to ART regimen (4.4%) in the post-restriction period. Regardless, VS (VL < 200 copies/mL) was maintained in 98.2% of people pre-pandemic, 97.8% of people peri-pandemic and 99.1% of people post-restriction. Conclusions PLWH within IDOC had sustained VS and COC throughout the SARS-CoV-2 pandemic with telemedicine. These results describe how the pandemic impacted PLWH in a correctional setting and future studies could contribute to creating national guidance for telemedicine models to streamline clinical practice through the utilization of telemedicine.

Keywords

• HIV
• Telemedicine
• SARS-CoV-2
• Correctional setting
• Antiretroviral therapy