Recommendation for In-Person and Virtual Care Delivery Among U.S. Servicemembers Living with HIV
Abstract
The COVID-19 pandemic introduced an unprecedented disruption in medical care. Consistent and uninterrupted care is necessary for servicemembers with chronic conditions including infection with the human immunodeficiency virus (HIV). Virtual health care, also known as telehealth, and hereafter referred to as virtual care, is a frequently employed solution to maintain medical care during disruptions such as those that occurred during the COVID-19 pandemic. This report examines the effectiveness of in-person and virtual care combinations in maintaining high-quality and cost-effective health care before and during the COVID-19 pandemic. Using medical records from the U.S. Military HIV Natural History Study for 1,294 active-duty servicemembers over Fiscal Years 2016-2021, we assessed three combinations (models) of in-person and virtual care. Model 1 consisted of virtual visits at a Center of Excellence (CoE) every year and in-person visits at the nearest Military Treatment Facility (MTF) with an infectious disease (ID) physician every 6 months, Model 2 consisted of in-person visits at a CoE every year and interim in-person or virtual visits at the nearest MTF with an ID physician, while Model 3 consisted of virtual visits at a CoE every year and interim in-person visits at a MTF or civilian clinic. The quality of care outcomes were based on the performance measures of the HIV/AIDS Bureau of the Health Resources and Services Administration and included regular periodic HIV visits, sexually transmitted infection screening, CD4 measurement, antiretroviral therapy receipt, and viral load testing and suppression. The cost outcomes included temporary duty yonder costs, lost duty time costs, and outpatient medical costs. We found that patients who had received care in the assessed models had higher quality of care than patients who did not. The higher quality of care occurred at the expense of higher costs due to lost duty time and outpatient medical care.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 25, 2023
- Accession Number
- AD1201988
Entities
People
- Brian K. Agan
- Charla Geist
- Jason Blaylock
- Jason F. Okulicz
- Nimfa C. Teneza-mora
- Robert O’connell
- Senay Topal
- Timothy Burgess
- Todd Gleeson
Organizations
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- San Antonio Military Medical Center
- Uniformed Services University of the Health Sciences