Utilizing Telemedicine as a Tool for Management of PLHIV at a Tertiary Care Institute

Abstract

ABSTRACT Telemedicine has been increasingly utilized in health sector. In our study we bring to light various applications of telemedicine consultation for patients receiving anti-retroviral therapy. We have observed that in a resource-limited setting, CD4-based assessment via telemedicine can still be useful, provided a serial record is maintained. We evaluated 430 cases in terms of demographics, CD4-trend and adverse effect profile. Tracking and monitoring of lost to follow-up cases could be done using this platform. Aim: The study focuses on the benefits of using telemedicine as a tool for consultation and referral of people living with HIV at centers located away from tertiary care institutes. Settings and Design: The study was conducted at telemedicine center, which is a tertiary referral center for all the districts in Maharashtra. We retrospectively analyzed the data obtained from telemedicine consultations carried out for patients from district-level antiretroviral therapy (ART) center. Methods and Material: The subjects who satisfied the following criteria were included for data analysis. Inclusion Criteria: All the HIV-infected persons on antiretroviral therapy enrolled at distant ART centers for which opinion was sought through telemedicine. This is an observational retrospective study. We reviewed the records of all patients enrolled in HIV healthcare through National Aids Control Organization from distant treating antiretroviral therapy centers (henceforth referred to as ART centers) for whom expert consultation was sought through telemedicine. These patients were given opinion for several consultations including response to therapy, management of opportunistic infections, drug-related adverse events, and treatment failure. We analyzed the demographics, the duration of treatment, and response to therapy. Statistical Analysis Used: Descriptive data analysis is used in this study. Results: We analyzed 430 case referrals through telemedicine from ART center. In 21% (N = 94) patients, CD4 was less than 50 and 11 cases had CD4 more than 500. An increasing CD4 trend was noted in 190 cases and a decreasing trend in 204 cases. In 36 cases, there was no change in CD4 progression. We had 20 cases lost to follow-up. The baseline regimen was Zidovudine Lamivudine Nevirapine (ZLN) in most cases (N = 237). Adverse drug reactions were the reasons for referral in 79 cases, maximum being AZT-induced anemia (N = 57). Of the total 430 cases referred, 253 cases had been wait-listed for SACEP meeting as per existing protocol. In 177 cases, physical attendance for the SACEP meeting could be deferred. Conclusion: Telemedicine has emerged as an immensely useful tool in management of People Living with HIV (PLHIV).