Guest Commentary: Use of e-health care in HIV has benefits, drawbacks
Declining HIV-related morbidity and mortality following the introduction of ART has changed the needs of patients as well as clinicians. One strategy for addressing these needs, e-health care, was discussed at ASM Microbe 2016. In this guest commentary, Anna Maria Geretti, MD, PhD, of the University of Liverpool, discusses the role of e-health care in the treatment of patients with HIV.
Virtual HIV care, or e-health care, is a transition in the way we manage HIV, because the virus can now be treated effectively for years with ART. Our concerns about treatment failure, toxicities and resistance have not been completely eliminated, but they are greatly reduced. We now have, with e-health technology, platforms that enable patients to access their information and receive counseling and consultations remotely.
Think about a patient who comes and has a blot test done. With e-health, that patient doesn’t need to come back for the results a few weeks later – he or she can simply log in through a secure server and see the results. Remote patient-provider communication could offer reassurance, perhaps through a Skype consultation or a text message that says, ‘Everything is okay, come back in 6 months.’ That same patient could have a prescription delivered at home. The e-health approach to HIV care is appealing for patients who maintain busy personal lives and want to reduce the number of hospital attendances. However, patients who utilize e-health care must be technologically savvy.
There are also concerns about confidentiality and the security of the information that is being exchanged. Patients require reassurance that the platforms are safe and that data won’t be compromised. These issues are obstacles to widespread implementation.
There is a significant role for e-health care in regions that have a limited number of HIV services or where, as we are seeing in many regions, HIV services are being concentrated to reduce the cost of care. Eliminating the need to travel long distances to clinic would also be beneficial for people who are not close to centers of care.
I don’t know that virtual access in health care will resolve the issue of adherence. What it may do is facilitate contact with patients who need more communication, or for whom it is not as easy to go to the hospital frequently, as something that is supportive rather than an intrusion of privacy. We first need to understand the reasons for nonadherence – which may not be the same for everybody. It’s always a delicate balance between wanting to help patients with adherence and making them feel that they are, essentially, under surveillance.
Utilizing e-health care for patients with HIV will require understanding the needs of each individual patient. This can be achieved through increased patient-provider communication and collaboration.
Leon A, et al. mHealth in HIV: Use of mobile technology for engagement, retention and treatment. Presented at: ASM Microbe; June 16-20, 2016; Boston.
Disclosures: The study was funded by a grant from HORIZON 2020, the European Union’s framework program for research and innovation. Geretti reports no relevant financial disclosures.