Successful implementation of telemedicine and pharmacy enhanced HIV services as response to COVID-19 quarantine among health insured patients in Argentina

BACKGROUND: Due to the spread of SARS-CoV-2 in Argentina, authorities implemented quarantine and community containment measures for 234 days during 2020, which may have hindered HIV care continuum. Our institution is the main ambulatory HIV care center for health-insured patients in Argentina, with 10500 patients in active follow up, mostly from Buenos Aires city (and surrounding areas) with a countrywide network. Since years, the institution achieved UNAIDS objectives of 90% ART coverage and 90% virological suppression. In order to minimize impact of quarantine in medical follow up, ART pharmacy withdrawals and virologic suppression, telemedicine (E-visits) and pharmacy enhanced services were implemented since April 2020 as contingency plan in pandemic lockout context.
DESCRIPTION: Telemedicine was based on linkage between institutional electronic medical record and WhatsApp through a specific application, allowing patient-physician video call through mobile devices. After each E-visit, a satisfaction survey (Likert type scale 1='bad' to 5='excellent') was submitted to the patient. Pharmacy enhanced services consisted in pharmacy delivery for patients in vulnerable situation (from our main pharmacy to either patient´s home or next-door pharmacy) and bimonthly withdrawals. To evaluate impact of these services, we analyzed number of medical visits, ART coverage, pharmacy withdrawals and virologicsuppression (viral load <200 copies/ml) in our population in 2020 vs. 2019 (non-pandemic year).
LESSONS LEARNED: During 2019, 34843 medical visits were done (no E-visits). ART coverage, pharmacy withdrawals and virologic suppression were 97.5%, 95.9% and 97% respectively. During 2020, 32400 medical visits were done, being 10355 (32%) E-visits. Median patient satisfaction was 5 points (IQR: 5-5). ART coverage, pharmacy withdrawals and virologic suppression were 98.7%, 98.1% and 94% respectively, showing success of these contingency measures in preserving patient follow-up and ART coverage, adherence and suppression >90%.
CONCLUSIONS: Telemedicine and pharmacy enhanced services were successful interventions in pandemic context for preserving institutional standards according UNAIDS targets. Due to high patient satisfaction, telemedicine should be implemented as standard-of-care in our population.