Leveraging mHealth, telehealth, and at-home testing in rural areas: Implications for the HIV care continuum

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Leveraging mHealth, telehealth, and at-home testing in rural areas: Implications for the HIV care continuum Randolph D. Hubach, PhD, MPH Oklahoma State UniversityCenter for Health Sciences Version date_ 05 2021 1 Conflict of Interest Disclosure Statement The presenter has no conflicts to declare. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Under grant number U1OHA33225 (South Central AIDS Education and Training Center). It was awarded to the University of New Mexico. No percentage of this project was financed with non-governmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Learning Objectives Assess health inequities in relation to accessing culturally competent medical care. Evaluate the role of rurality and cultural norms on primary, secondary, and tertiary HIV prevention intervention. Identify shifting paradigms in HIV care and related public health/medical intervention. Ending the Epidemic: A Plan for America Role of Place: Rural Health Current debate on what is urban and what is rural Classification shortcomings New approach: "How rural is it?" Accounts for population size, density, distance to metropolitan areas Extreme rurality is absent from most areas 6 Background Rural populations Experience numerous barriers to medical and mental health care Less likely to be engaged than their urban counterparts Lack of access to affirming providers Substance use; mental healthincluding loneliness and isolation access to HIV testing Telemedicine and mHealth At-home testing Background Rural Context Geographic estrangement from other men who have sex with men (MSM) Estrangement from venues that serve gay and bisexual men Medical and mental health shortage areas Systemic homophobia Structural stigma May not identify as "gay" or "bisexual" and thus may not include themselves as a member of LGBT community Ending the Epidemic: A Plan for America Previous Studies & Findings Breakdowns in the PrEP continuum for rural MSM Low uptake among rural MSM Geographic isolation Access to providers LGBT-sensitive medical care Limited HIV & STI screening PrEP and HIV-related stigma Structural level Within group Previous Studies & Findings Aimed to predict what influences MSM to inform their providers of their sexual behaviors Age For every year decrease in age, the odds were 4% higher that a participant inform their provider Level of disclosure For every unit decrease in NOS-D (overall disclosure in one's life) there was a 3% decrease in the odds that a person would disclose to a provider Disclosure to medical providers vs mental health providers 11 Results Telemedicine Appeal Negative experiences with medical and mental health providers within their communities that led to them 1) seeking another provider within an urban center or 2) falling out of routine necessary care Ability to utilize telemedicine to overcome known barriers to care, such as distance to a local provider or specialist, was appealing Results There is a community clinic here (rural Oklahoma town) but after the first visit, they dumped me as a client or as a patient because they didn't want to see me because they're a somehow Christian-oriented organization and they didn't want me there because I'm gay but it's very frustrating and then I went through 4 years with no healthcare at all. Now I go to Tulsa to a clinic. I love them, but it's an obstacle to get there. Well for probably about 15, or more than 15 years, I haven't had steady medical care at the same time I was getting diabetes. So you know when you go five years with diabetes without getting medical care it would be a gift from the universe to be able to do it by video conferencing online. Results Telemedicine Appeal Access to knowledgeable and affirming providers This kind of goes back into being comfortable with somebody who does specialize or has experience with LGBTQ health in addition to saving time, trying to find somebody cause it's the closest specialist is an hour away versus a telehealth appointment and that's gonna really impact the ease of access. Cause going into a doctor's office with that kind of thing (sexual health concern). And especially from a rural area, sometimes you don't know what kind of doctor you're going to have. So it's hard to ask them those kinds of questions Results Telemedicine Appeal Enhances patient-provider communication I'm from a rural town in southeastern Oklahoma where this sort of thing (discussing sexual orientation/behavior), I would not be comfortable talking to with the doctor I have there. I think it would make me more willing to, or more comfortable with it, to be honest with you. Um, I think with him not being in the same room would, uh, be a little more, uh, soothing I guess so that you're not, uh, apprehensive about disclosing anything, Talking to somebody on the internet is easier than saying something to their face while they're in person. Findings At-Home Testing Appeal Access to testing programs that were Convenient, reliable, to the extent possible confidential I would just feel awkward, like going into a store and buying, buying [sic] it like at my pharmacy or something. I don't think I would feel comfortable checking out with that. Um, yeah, so just getting it in the mail where it's just in a box and you can just open it. It's a lot easier. Implications Implications COVID-19 and HIV Recent ramp up of telemedicine due to COVID-19 has led some rural populations to recently experience telemedicine visits for linkage to their care provider Has led to a greater need for virtual healthcare services and advancements in telehealth and telemedicine services being provided Increasing primary and secondary prevention activities to rural at-risk populations HHS allocated $20 million for expansion of telehealth services Potential paradigm shift in the delivery of care for rural and underserved populations in the near future HHS=health and human services 18 THANK YOU [email protected] https://www.sexualhealthresearch.org Resources National Clinical Consultation Center http://nccc.ucsf.edu/ HIV Management Perinatal HIV HIV PrEP HIV PEP line HCV Management Substance Use Management AETC National HIV Curriculum https://aidsetc.org/nhc AETC National Coordinating Resource Center https://targethiv.org/library/aetc-national-coordinating-resource-center-0 Additional trainings [email protected] www.SCAETC.org