Evaluating the integration of telehealth in same-day antiretroviral initiation service during COVID-19 in Bangkok, Thailand

BACKGROUND: Same-day antiretroviral therapy (SDART) initiation has been implemented since 2017 at the Thai Red Cross Anonymous Clinic (TRCAC), an HIV testing center in Bangkok, Thailand. Clients who are willing and clinically eligible start ART on the day of HIV diagnosis. In response to the COVID-19 pandemic, a lockdown was announced in Thailand in March 2020, limiting access to health care facilities. Telehealth for SDART follow-up was established at TRCAC to minimize clinic visits. We present an evaluation of its implementation.
METHODS: Pre-COVID (until February 2020), clients who initiated SDART received a two-week drug supply and returned to the clinic after two weeks for clinical evaluation and referral to long-term care facilities. If no adverse events (AEs) were established, an eight-week supply was provided while referral was arranged. During COVID-19 lockdown (March'May 2020), a four-week ART supply was provided, and the option of a video call for clinical consultation and physical examination instead of clinical visit at two weeks was given. Clients with severe AEs were required to return to TRCAC; those without received another six-week supply by courier to bridge transition to long-term facilities. A subset of clients was interviewed to assess experiences and preferences.
RESULTS: During the lockdown, 238 clients were diagnosed with HIV at TRCAC, 183 (76.9%) were eligible for SDART, 176 (96.2%) accepted, and 160 (90.9%) enrolled. Of 159 (99.4%) follow-up visits completed, 52 (34.4%) occurred virtually'all with clients who did not have AEs prompting a clinic visit. Seven clients were interviewed; all experienced telehealth as positive and found it convenient and time saving. Due to the success of telehealth with ART delivery, it was continued. Post-COVID (June'August 2020), 406 clients were diagnosed with HIV, 319 (78.6%) were eligible for SDART, 297 (93.1%) accepted, and 283 (95.3%) enrolled. Of 232 (99.2%) follow-up visits completed, 83 (38.8%) occurred virtually.
CONCLUSIONS: Telehealth follow-up with ART delivery for SDART clients is a feasible and safe option for providing differentiated ART initiation services at TRCARC, leading to its continuation beyond COVID-19. Therefore, telehealth in hospitals and for purposes beyond ART initiation should be explored.