Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA.
J Pediatric Infect Dis Soc. 2024 Jan 29;13(1):60-68. doi: 10.1093/jpids/piad102.
During the COVID-19 pandemic, many US youth with HIV (YHIV) used telehealth services; others experienced disruptions in clinic and antiretroviral therapy (ART) access.
Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent HIV microsimulation model, we evaluated 3 scenarios: 1) Clinic: in-person care; 2) Telehealth: virtual visits, without CD4 or viral load monitoring for 12 months, followed by return to usual care; and 3) Interruption: complete care interruption with no ART access or laboratory monitoring for 6 months (maximum clinic closure time), followed by return to usual care for 80%. We assigned higher 1-year retention (87% vs 80%) and lower cost/visit ($49 vs $56) for Telehealth vs Clinic. We modeled 2 YHIV cohorts with non-perinatal (YNPHIV) and perinatal (YPHIV) HIV, which differed by mean age (22 vs 16 years), sex at birth (85% vs 47% male), starting CD4 count (527/μL vs 635/μL), ART, mortality, and HIV-related costs. We projected life months (LMs) and costs/100 YHIV over 10 years.
Over 10 years, LMs in Clinic and Telehealth would be similar (YNPHIV: 11 350 vs 11 360 LMs; YPHIV: 11 680 LMs for both strategies); costs would be $0.3M (YNPHIV) and $0.4M (YPHIV) more for Telehealth than Clinic. Interruption would be less effective (YNPHIV: 11 230 LMs; YPHIV: 11 620 LMs) and less costly (YNPHIV: $1.3M less; YPHIV: $0.2M less) than Clinic. Higher retention in Telehealth led to increased ART use and thus higher costs.
Telehealth could be as effective as in-person care for some YHIV, at slightly increased cost. Short interruptions to ART and laboratory monitoring may have negative long-term clinical implications.
在 COVID-19 大流行期间，许多美国青少年 HIV 感染者（YHIV）使用远程医疗服务；其他人则在诊所和抗逆转录病毒治疗（ART）方面遇到了中断。
使用预防艾滋病并发症的成本效益（CEPAC）-青少年 HIV 微观模拟模型，我们评估了 3 种情况：1）诊所：面对面护理；2）远程医疗：虚拟就诊，在 12 个月内不进行 CD4 或病毒载量监测，然后恢复常规护理；3）中断：6 个月（最长诊所关闭时间）完全中断护理，无 ART 治疗或实验室监测，然后恢复常规护理 80%。我们为 Telehealth 分配了更高的 1 年保留率（87%对 80%）和更低的每次就诊成本（49 美元对 56 美元）。我们建立了两个 YHIV 队列，分别是非围产期（YNPHIV）和围产期（YPHIV）HIV，两者的区别在于平均年龄（22 岁对 16 岁）、出生时的性别（85%对 47%为男性）、起始 CD4 计数（527/μL 对 635/μL）、ART、死亡率和 HIV 相关成本。我们预测了 10 年内每 100 名 YHIV 的生命月数（LM）和成本。
在 10 年内，诊所和远程医疗的 LM 相似（YNPHIV：11350 对 11360 LM；YPHIV：两种策略均为 11680 LM）；远程医疗的成本比诊所高 30 万美元（YNPHIV）和 40 万美元（YPHIV）。中断的效果较差（YNPHIV：11230 LM；YPHIV：11620 LM），成本也较低（YNPHIV：少 130 万美元；YPHIV：少 20 万美元）。远程医疗中较高的保留率导致 ART 使用率增加，从而导致成本增加。
对于某些 YHIV 来说，远程医疗可能与面对面护理一样有效，但成本略高。ART 和实验室监测的短期中断可能会产生长期的负面临床影响。
