Chapters Transcript Video The Potential of Telehealth in Helping to Address Barriers to HIV Care May 11 2021 The Potential of Telehealth in Helping to Address Barriers to HIV CareOriginally Broadcast: Tuesday, May 11, 2021 12:30 PM - 2:30 PM EDT Hello. Happy Tuesday. I'm Christopher Chance Watson, Associate director of HIV marketing at Gilead Sciences and on behalf of our employees worldwide, we would like to welcome you to our third installation of our blueprints for success training institutes. Today's program will look at the opportunities that telehealth presents in overcoming barriers to HIV prevention and care services for hard to access population. Before we go, I would like to briefly welcome our agenda for today to 20 minutes workshops. Excuse me, 2 20 minute presentations and 1 45 minute workshop. Our first presentation will be given by Dr deem Adachi and it's entitled Health Disparities and telehealth, alleviating or accentuating the problem. Our second presentation will be given by Dr rob Stephenson and is entitled the role of telehealth and ending the HIV epidemic. Each presentation will contain questions so that you the viewer can interact with our speakers. Each question will appear to the right side of your panel on the screen and you'll be able to click on your responses to see the results. Our two presentations will be followed by a workshop that will be led by our community liaisons and it will focus on the potential role of telehealth in supporting patient management at each stage of the patient journey. Afterwards. We'll all come back for a panel discussion in audience too and a session where you have a chance to ask our faculty questions on the content of today's program. Please click the bottom but the screen to submit a question anytime throughout the program. After this program ends, you will receive a toolkit that includes helpful information that was reviewed during today's program. Without pleasure. It gives me the moment to introduce dr David Malebranche. Dr David Mill Branch will serve as our host for today. He's an internal medicine physician and an HIV specialist located in Atlanta Georgia. He has specific training and expertise in men's health correctional health, student health, racial inequalities within medicine and L G B T. Q health, as well as the prevention and treatment of HIV and sexually transmitted infections. Dr male branches, passionate about community engagement and outreach and appears in the video series Hashtag Ask the HIV doc, which promotes education and empowerment on HIV prevention and treatment as well as Revolutionary Health, a weekly Youtube Live Health Web series. That is part of the counter narrative project, which is an advocacy organization for black, same gender loving man. Without further, do you please allow me to welcome Dr David Malebranche. Thank you very much, john c um uh, in addition to all those illustrious things that you said about me, I'm also an expert at preventing people who are about to take myself away from knocking on the door while I'm supposed to be speaking on a live webinar. So um I got explicit training in that in public health and medical school but I digress um our first presentation today will be given by Dr Dean Daci as chancy alluded to. And I want to just tell you a little bit about her before she does her presentation, she holds several positions at the University of Missouri Columbia, she's an assistant professor of medicine, she's the medical director of the HIV aids program in Emu Healthcare and also the medical director of the outpatient antimicrobial therapy and vascular access team in the division of infectious diseases, in the department of medicine. So without any further ado I'll turn it over to Dr Donda chief for her presentation today. Thank you. Dr Malebranche. Yeah. Oh yeah, okay. So before we get started into the tele house and health disparities and whether Della houses making the problem better or worse, let's look at the snapshot of HIV in the United States. So there's an estimated 1.2 million people living in the United States with HIV. Unfortunately, almost like 14 of them. They don't know they have HIV because they need testing and although we had a great improvement in HIV incidents and new HIV infections between 2014 and 2018 with the reduction of seven of new HIV infections, this is not the case in all geographic areas and for all groups. So next, we will be talking about the factors that impact these health disparities and you will see up only question on your screen now. So if you could please go ahead and answer that. So what are all of these factors do you believe it most affects a person's ability to achieve good health. Is it race or ethnicity? Sex, sexual identity, age, disability, socioeconomic status or the geographic location. So, um there's no right and wrong answer for this question. All of these factors impact health disparities. And we will be talking about each one more in details. So next next slide, we will be talking about what is health equity? So health equity is not the equivalent of the absence of disease. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. And moving to the factors that affect health equity. We have. We know that poverty and rural existence are major factors that affect health equity. So in 2018 there are 2.6 million Americans working full time jobs and still are below the poverty line and this annual poverty that is expected even to increase For rural existence. The in 2010, the US. census said like rural areas covered almost 97 of the nation land but only contain 19 of the population in rural Americans face many health inequities compared to people living in urban areas. And I could tell you this from my own experience, moving from Houston in Chicago to Missouri. And there is a major difference. It's beyond our talk today, but there's a lot of a lot of difficulties in access to care when it comes to rural areas. The next we will be talking about these specific uh the specific factors. So looking first at the geographic location, We know that half of new HIV infection happened and only in the southern states. However, only 38 of the us population live in this region. In the same idea. The next slide, we will be seeing like how the hell the overlap between socioeconomic and health conditions in counties with disproportionate black population mostly in this house. This slide is very interesting, very nice because it's very visual and it cannot show like it clearer than that. How is this overlap between. You see how the overlap between poverty, unemployment and insurance and syphilis, diabetes and heart disease. So this is definitely affect all these conditions. The geographic location. Next we will be talking about like how race and HIV new diagnosis kinda intersect. So in 2018 black and African American accounted for 42 of the HIV diagnosis. But we know that there are only compromise 30 of the population, Same for Latino X. There are 27 of new HIV diagnosis, but there are only 18 of the population. So you see how this health differences among among grace and in certain populations. So 70 of new HIV diagnosis happened among men who have sex with men and transgender people have three times the national average of New HIV diagnosis. Next, we see that actually not only that it's higher in among men who have sex with men and certain population in certain races, there is also this intersection of phrase and sexuality. So black and Latinos, gay and bisexual men are disproportionately affected by HIV more than uh, more than white, uh, gay and bisexual. And next slide, we'll talk about that age as the young people at highest risk of HIV. So remember in the first line, we said that overall we know that 15, almost 14 15% of the people who have HIV, they don't know have HIV. So you look at the here, the percentage over here for the people who are between 13 and 24 years of age, the youth and half of them, they don't know they have HIV because we don't test them As frequently and even if we test them and they are diagnosis, they are diagnosed with HIV. They are less likely to receive care, there is less likely to be retained in care. And they have the lowest rates of virus suppression. Like if we're talking overall people HIV have 53 in the US. virus suppressed this group, only 30 of them are virally suppressed. So from uh you know I think like most of the people kind of thought that socioeconomic status and race or ethnicity and geographic location are the three most important factors and as we said, there is no right or wrong all these factors affect the affect a person's ability to achieve good health. Next we will be talking how that this historical trauma is passed down over generations and it potentially impair their ability to cope effectively. It will leave an imprint of America on the epic genome. It affects the pregnancy, has conditions that could affect negative, that could lead to negative house outcomes and definitely contribute and even lead to this current health disparities. So trauma does not impact only the individual, but the family and the community overall. So next we talked about uh so here we're going to explore what is the HIV status neutral kid continuing. So probably most of you are familiar with the term HIV care continuum. Right. And this is the part that's in red in this slide. So this is when someone is diagnosed with HIV. What we try to do is to get them in care, retain them in care, start the military to viral and uh and maintain viral suppression. But HIV status neutral does not end. It incorporates people who are at risk for HIV and it all starts with HIV testing. So HIV testing is someone that's positive that will go through the HIV care continuum of treatment. We're diagnosing the detention in care and various oppression, but people who are at risk, we also need to engage them in care and provide them with all the prevention options that we have, whether counseling, medication and so on in order to reach to end the HIV epidemic. So, but you could see that not this HIV status neutral care continuum is not affected, is not affected only for people who got diagnosed with HIV, but also before even an HIV diagnosis even made and all the social determinants that we talked about can affect that. Um, next. So yeah, so we talked about these factors that could affect people and getting trying to engage them into care and it could be even more difficult to engage papers and care in HIV prevention because remember these people don't don't know, they don't feel they're sick, they don't feel they need to go to a doctor. So all of this is probably maybe even more challenging than keeping people engage in care and HIV treatment. All right. So after that, moving forward, we have um next one please. So, so it's not a surprise for all of us that there is unequal distribution of HIV burden of disease. And now we will talk about like how to close these gaps. What are we need really new strategies and models of care to reduce these barriers to access and adherence. So dr Fauci, this is from the uh what he said is to end the HIV epidemic. We must close this implementation gaps to ensure that all people with HIV are diagnosed and receive the treatment and care they need to achieve and maintain violence oppression. So how can we do that? And this is the what we will explore the next slide so how to become more inclusive, inclusive and how to increase our efficiency. So first we have to help eradicate structural racism by initiating self reflection and addressing bias among health care providers. And I experienced that like so often with our med students and residents when they rotate with us an I. D. And really like the misconceptions, the prejudice they have and the and the biases they have should be addressed even before even addressing the patient before even talking to the patient. And and then we need to seek to address the social inequities outside of the border of our healthcare facilities in the community and most importantly empower individuals by partnering with community based organization to develop public education and celebrate minority identities. So that's in general. Moving forward. Can tell a house B and this is when we wanted to discuss, like can tell how speed the next disruptive innovation in HIV prevention and treatment. So what does it mean when we say disruption in healthcare or disruptive innovation? So disruption in healthcare occur when diseases with effective treatment, but for which the delivery model of those treatment continue to have gaps in care. So, uh, my mentor used to say we really have all the means to end the HIV epidemic. We don't need fancy drugs, we don't need um new drugs and new development. We're still going to work on HIV cure and HIV vaccines and so on. But at this moment we do have all the means to end the HIV epidemics. And this is exactly what we talk about disruption and healthcare where we do have the treatment, we do have effective treatment and prevention, but we're not reaching to everyone. So tell the house is considered by some to be a disruptive innovation that could change healthcare. The townhouse in HIV has has been around sometimes this is not a new new thing, but it has been here and there. And uh, You know when COVID-19 came, we are we were all forced to start using tell the house whether we like it or not, but definitely to house can address some of the barriers to access um, to care a HIV care with the treatment and prevention. So when we talk about telehealth moving forward, when we talk about telehealth, what is telehealth? So Tell a house is a big umbrella. And it can be confusing because we used this word interchangeably and even when we look at studies it's sometimes hard to compare like studies two studies and outcomes because Tell House is a big umbrella that has a lot of meaning in different modalities under tele halls. So we have the live video conferencing, maybe some of you have experienced that. And this is where the patient and the health care provider has real time interaction and consultation. And then we have the store and forward where the patient data gets transmitted to a health care provider. You base your decision and the treatment based on this um data but you're not interacting in real time with the patient. We have the remote patient monitoring and this has been used in other also medicine fields. E I C. U. Has been for quite some time now. So this is when we have the medical data of the patient is transmitted in real time monitoring. But there is no direct and real time interaction between the patient and the provider. And we have mobile health. Mobile house has been studied quite you know often in HIV care and this is when we talk about mobile health as an application in order to support health care, whether reminders education and so on. So here's another question for you that I would like to ask you about. So to what extent your organization have implemented telehealth um, in any of these modalities. So you see this polling question, if you could please answer that and next we will be talking about can tell the house be this potential have the potential to expand access to care across the HIV care continuing. And we know that by theory it should, it could be important for certain groups and certain groups can benefit from, to help the most, maybe in rural settings and among youth because, you know, there are tax savvy, they're used to these types of communication. Maybe there will be more um kind of uh, okay with using this technology to to get their care and people who are stigmatized and they don't seek HIV care because they are concerned about the chinese stigma. Um, also it could be used in hard to reach populations, including incarcerated people and people who have like a transportation barriers. Transportation barriers is one of the current theme that's listed always when it comes to barriers to HIV care. And this definitely could solve some of these problems. So next we're gonna be talking about what are the benefits? So we talked about all the groups that could benefit from tel house. So what are the advantages that we could have potential benefits from Tala House to expand this access to HIV care? So we know that it could decrease waiting time and health facilities. I had people, you know, like connect with us and have their own appointment during their lunch break at work versus like in the past they would need to take like a half day or even a whole day off in order to come to clinic, more convenient clinic hours, reduce the stigma, reduce unintended disclosure, better access to healthcare providers. Uh and HIV education opportunities may be increased patient support. So, all of this, all of these factors. So um I would like to ask your opinion here also about what are from this, from these benefits, the most valuable benefit of telling house to your organization, if you could answer that. All right. So we talked about the benefits. So these are the potential benefits for Teller House but tell us has also its own challenges and limitations. So as a health care facility and as providers reimbursement policies is a big thing that we need to focus on. And it's always kind of an issue that is discussed when we talk about telehealth and implementation after the house access to video and or broadband video like to establish this in a facility. And from the patient perspective privacy concerns, we know that you know like issues about safety, the data safety over internet, it's becoming more and more of an issue and definitely on many people's minds regulations and policies in place that would limit prescribing and patient and provider uptake. So as I said, we are all forced now to use probably some to some extent um tell the house and if I see like uh probably The I would say a third said that you implemented kind of to a moderate extent telehealth. So so that's kind of a good percentage and 2020 said even to a small extent or to some extent is to some extent and 26 answer to a large extent. So almost all of us now experienced some form of the house or have experienced that. So um moving on to um So these are the tell the house consideration, you will get this slides in the toolkit uh later after this presentation. But these are the consideration that you have to think about when you're trying to implement it to the house program in your facility or even expand at the House of program already existing in your facility. So what are the clinical consideration, the administrative consideration, technical, personal. And from reimbursement perspective. So these are the things you can think about systematically in order to see what are the barriers that you could face and how can you try to prevent that or have a plan in place? So the next we'll be talking about. So what is the impact of telehealth on the health care system? So we know that it might improve access to care and distribution of limited providers. I will tell you like there are many areas and then you ask they are designated as healthcare provider shortage areas. And for example where I practice there are people that drive like three hours, 2-3 hours to see an HIV care provider. And and that you know like you can imagine how this could be a barrier of care when you are when you don't have to the house and you have to every time you need to go get left and see and actually provided to that to drive 2-3 hours. It could be from healthcare system and cost effective. Also mode delivery, mode of care. So definitely that's also part that we could consider. But there are all kinds of policy barriers impacting the providers and institutions from implementing uh tell house in their system. So, first, as we talked about reimbursement, um malpractice licensing and uh and these all have been kind of a little bit loosened up and, you know, opened up for during the covid time. So they all these all these regulations and rules were relaxed so it it made it easy to implement, Tell a house and how much this is going to go back in the future. We're going to see and we're going to see how things are going to be in the future. Um all the issues about privacy, security, and hip hop that comes with it and prescription over the internet. So in in different states, it's very complicated sometimes because in each state they have their own rules. So some state prohibit prescribing if you have not had encountered the patient for the first time. Uh did you have to have at least one face to face encounter before prescribing medication over their internet? What about if the patient like? We have a lot of patients for example, living at the they drive to see us, but they are in the border from different states. So how about prescribing for patients who are in a different state Credentialing and privileging like is it different for telehealth? So there are some states that have like different credential and privileges depending if you are practicing Stella house or in person. So, but I would say most of you said uh they better access to healthcare provider would be kind of the most important benefit for tell house and decreased waiting time at the health care facilities. I think I agree with you, this is a big thing and reduce the stigma. Um so especially especially when, you know, reduce the stigma experienced, especially when you are practicing in an HIV clinic and people know if you're going in and outside the clinic that you're going to an HIV clinic versus if you're practicing in a more of a general clinic, then this is less of a kind of known, where are you going and who you're seeing. So definitely I agree with all these potential kind of benefits for telehealth Next. Um we talked about the uptick from providers and from the patient perspective, and again, this is uh we will see how this will play out in the future in a study that we did. And that was back in 2018 about what to patients with HIV think about using tell a house with the HIV kid. And we saw over 371 people living with HIV, 57 of those said they were more likely to use that a house with their HIV care if available as compared to in person face to face visit. And 37 said they would use it frequently or always as an alternative to clinic visits. But again, keep in mind this was done before the covid before. So these people didn't have any experience with the house in the future. And there is a difference between posing a theoretical question and saying, would you be willing to use it or would you like to use this technology if available to you and keep using it for the future? You know, like you might say, okay, I'll try it once, but then if you're gonna keep continue using it, that's the that's the difference. And this is where we're going to see in the future how things are going to be. And we need more research about that. So, next in summary. So we know that we have great advances when it comes to a chinese prevention and treatment. But unfortunately not everyone has equal access, um, different groups and different, you know, races and all these social determinants of health impact, health equity. And we really need to close these gaps in order to reduce these barriers to access and adherence and uh, potentially broaden access to HIV care. Tell the House can definitely be more affordable and can improve access to a lot of the barriers that people with HIV whether in prevention or care face. But you have to remember that tell House is not without any limitations. So it has its own limitation and it challenges. So we have to keep that in mind and probably this is something in the future to explore who would be the most um who would be the groups that would benefit from? Taylor has the most who we should we offer it to and what are the challenges that we're going to face in the future? So, thank you so much for listening. I'm sorry if I went so fast in certain places and I'm happy to answer any questions later on. I will now turn it to dr Malebranche, Doctor linda, thank you so much for the excellent presentation. Um you don't have to apologize for going a little bit over. You covered so much with not only looking at the social contextual factors that influence, but then discussing HIV neutrality, then going into telehealth what it is and why it's going to be important. So please um you know, I think the five minutes were well spent, so thank you for that excellent presentation. I'm sure we'll have a lot of questions after the breakout sessions. So without any further ado I want to introduce our next presenter who is going to be dr robert Stevenson. Dr rob Stevenson is a professor and director at the Center for Sexuality and Health Disparities at the University of michigan in ann arbor michigan. And I'd like to turn it over to dr Stevenson now. Thanks, David. It's uh nice to be here. Thank you everyone for inviting me here today. I'm going to follow on from Doctor Do Naches Talk, who gave a really nice introduction to the HIV epidemic in the US and some of the potential for telehealth. I'm going to talk a little bit more practical terms about how we can use telehealth to improve access to HIV care throughout the U. S. So I want to start with maybe the bad news, which I know is not the best way to start. I'm going to talk start by talking about what happened over the last year with the covid pandemic and how it's really influenced the access to quality HIV prevention and care services. Now, I want to think about this in two ways, there are two primary ways that the covid pandemic, really decimated access to HIV quality. Uh first of all, and this is obvious the need for the lockdowns. The need for physical distancing really meant that it was almost impossible to provide lots of the routine HIV prevention occur that we used to. And this disproportionately affected more vulnerable communities, Communities of color, communities living in poverty, communities characterized by lack of access to other resources. And what we really saw was a lot of services such as community based HIV testing or community FBI clinics really would just have to close because of physical distancing rules. The other way that the covid pandemic influenced the access to care was just the need to redirect both personnel and financial resources towards Covid. So, I work in a university with a very large medical system and I can tell you just the sheer number of of health personnel. We were taken away from other routine services and were redirected towards Covid. And you know, with this went the money, a lot of especially community services, routine HIV testing, a lot of that has just had to close and it's really disproportionately affected communities that have layers of structural vulnerability. So that's the bad news, which is a really good way to start. I know this, let's talk about the good news because opportunity in crisis. Um, there has some has been a little bit of good news. First of all, there's been some interesting financial things that happened with Covid. I don't know if you know about this, but the cares act meant that there's another 100 55 million that has been redirected, especially for improving access and access, is the key word here. Access to quality, HIV prevention and care programs. The second, and what Covid essentially did was telehealth into the spotlight. What I want to make really clear here is that we did not invent telehealth last year, that seems to be how we think about it. Everyone something discovered, telehealth, telehealth has been around for about 2030 years and it was kind of like the forgotten step child of healthcare provision. It was very rarely used. It was often seen a specialist care. It was actually often only used by the more affluent. All those have insurance, The access telehealth. Um, but what Covid did was I think it Covid in some ways became a great level. It forced telehealth into the spotlight forces to think about telehealth. The physical distancing rules and the lockdowns meant that we had to find new ways to meet our patients. And so there's been an incredible growth in telehealth a little last year. And that's really what I'm going to talk about today. Mhm. Just some general advantages of telehealth. I'm going to talk about advantages in terms of what it did for the Covid epidemic and then also what it can do for provision of quality HIV care as well. So, first of all, and this is perhaps an obvious one providing telehealth meant that we could still provide quality health care and idea to physical social distancing Rome's we no longer had a crowded waiting rooms. We no longer required people to travel and be on public transport and actually go to a physical health center. And so there is obvious hotel health has had a key role in preventing the transmission of covid. Second, it brings specialist care two occasions and this is something that I'm particularly passionate about and I'm going to talk about this in my own research later, is what telehealth did. It's a mounted a lot of the barriers to accessing care doctors we talked about in her previous presentation. Think about the people who cannot access care, people who live in rural areas, people with disabilities, people who might not have the right health insurance, people who are living in poverty, all of the people who just, I don't feel comfortable because perceived or actual stigma and discrimination, but don't feel ready are able to go to a health care setting. What telehealth does, It puts health care in their own home, it puts in their own hand on their smartphone and it gets around a lot of those barriers in absolutely no way. Does it cover every barriers? It's not the golden ticket that answers everything, but it doesn't amount a lot of those barriers. It helps with triage and treatment. You know, I've used telehealth a lot over the last year, It's just so handy to be able to like get on a quick video call with my provider. Like I've got this worry, I've got this concern. Should I go into a health care facility? And so it helps health professionals identify who actually needs to come in for care. What's really important is that telehealth broadened the scope of services that can be provided. And this is what I, what I see is the major advance forward over the last year. Were tended to think of telehealth as like a doctor in a white coat and a patient on the video screen and that during the regular visit so much more you can do with telehealth and that's not going to talk about today. You can provide social world, you can provide counseling services, referrals to food pantries, all kinds of things. So we have our first polling question coming up and I want you to think about to what extent have you observed the advantages of telehealth in your own organization? So while you answer that, I'm going to move on and start to talk about the scale of telehealth over the last year. And as I said, I have a graph coming up to to show you this. It's 2019. Was the year of telehealth, No, 2020. So I don't know what year is. 2020 was the year of telehealth. The data from cais appointment from an empty that you see here on the left, They did 31 million telehealth visits. But what's interesting is that 18 times the number of visits they've done the year before. And then if you look over on the right, 76 of US. hospitals Uh started to move the health visits into telehealth and this strong regional variations. As you see in the map above, in the northeast there was a 9000 increase in telehealth. That's amazing. In the space of a year, I can't think of another health indicator or another indicator of the provision of health care. That changed so rapidly in just 12 months in the south. It was only 1000% increase. And it could be that there's some differential access to services regionally or there may be other indicators of structural vulnerability that are deferentially distributed across the U. S. So telehealth is obviously not accessible to everyone. But what I'm going to talk about today is that we can make it acceptable. So while I wait for the polling results, let's move on and talk about uh some of the trends that we've seen in um hello house Again. Everyone thinks that we invented telehealth last year. We did not have been a different formats for a number of years. Look at this graph, we look back to 2014. It was a really tiny proportion of visits were done by telehealth. It was really quite an elite boutique servants. And if you follow this upwards towards 2018, about two years before covid hitters, you can see that this rapid increase in telecom, the most common was provided a patient. So basically doing something like I'm doing now using zoom providers using zoom to talk to their patients. Um, I want to draw your attention to the scale. This is one of those graphs where you look at it like wow, telehealth is beating freezing forever. It's still only, you know, 10, a 10th of one of all visits were done by tomorrow. Contrast that to the 9000 increase we had just in the last year in Telehealth visits. And so I see your poll results coming in slowly now. Uh, and it seems that at least 40 of you have seen a lot to see seeing a large extent in your organizations that there's been an increase in telehealth. And that's really interesting. I want to talk about that later and talk about what kind of changes you've seen. However, moving on, let's talk a little bit more about how we apply the Telegraph techniques specifically to the provision of HIV care. And I'm going to be talking about HIV prevention and HIV care. And I'm not talking about how, how include all those wraparound services as well. Remember I said at the beginning of the presentation how telehealth is really, you know, being used for a whole bunch of other health care issues, not just HIV. And I'm gonna start by telling you how about the HIV literature. Sorry, don't look for a minute. And uh, you know, where we've been using telehealth? Traditionally telehealth has its roots in HIV care, not HIV prevention as a whole literature out there, I'm happy to share with you. That shows that people living with HIV who use telehealth they're more likely to be retained in care. More likely to be at ease and they're more likely to be very suppressed. That's not rocket science when you think about it if I'm having problems in that A. I. T. And I've got to make a appointments to see my doctor. I've got to get a bus I've got to go and see my doctor. All these kind of things. I'm already over that and I can't be bothered to go if I can just use telehealth and make an appointment online quickly or you know have a quick uh text message chat with my doctor that makes it so much easier. And that's what telehealth is about. It's about some mounting these barriers and making it easier for your patient. We also know that those who with HIV diagnoses are much more likely to initiate a. I. T. After after a positive diagnosis. And there is some really interesting emerging evidence or in print as well that men are particularly gay bisexual and other men have sex with men who are candidates for prep. I'm much more likely to take prep and a deer to prep easier to actor and easy to access. I mean they can have a quick telehealth chair and they can just get descriptions by texting the doctor, how easy is there? So let's think a little bit more specifically about how we do this. So some of the lessons land around telehealth for HIV. We know that it can help reach those who may not engage through traditional methods and by this I mean those who are the want come into a physical space or can't come into a physical space and I'm worried about both. As a as a provider. I would be worried about both groups of those people. It reduces stigma and discrimination and doctors amount. You did a really nice job in her presentation. So talking about how stigma and discrimination prevent people coming into services if you've got a provider who you like and you know you don't have to walk into a clinic with everyone watching you, why can't you do it via video chair? Um It helps simplify the process of healthcare delivery. Um Not over sharing but when I use telehealth, what I really like about it is the use of a patient portal. I can see everything in one easy physical space. You can even be used in an app. I can see my test results, I can see the summary of my visit and see my appointment even like do my copay before I get that, before I do my telehealth visit. Having it in one kind of like a one stop shop for everybody. That's what telehealth does. This is one of those myths that I want to explode. It offers a broad array of services. Again, I've already said this, we think of telehealth is just the doctor and the patient talking. There's so much more you can do about it to do with it. You can do HIV testing, you can screen people for prep, you can do social work, you can link to food pantries, you can do substitutes, referrals, all of that. And those wraparound services can be done by a prep, but it also provides a range of interaction or doubt and by that, I mean it doesn't just have to be video chair. Um there's lots of telehealth options where you cannot have your camera on if you don't feel comfortable talking about it and your and your help actually seeing you, you can do text only. There's many different ways of doing it. So it's time for another one of those polling questions. Which one of the patient outcomes are you currently are is your organization's highest priority. And so while you answer that polling question, I'm going to move along. I'm going to talk about a couple of my own studies. These remember these are research studies, this is not the actual, this is not the live provision of care. These these are done in a research environment. And I'm going to talk about two studies that use telehealth to provide HIV testing. The first one is called project nexus And this was a study of male couples. So two men neurological friendship. It's really simple. This is what we do. We recruited male couples online, about 560 of them and we randomize them to two arms in the control arm. They got the standard of care. All we did was send them to HIV testing kits. And so test yourselves and tell us the results. Don't actually physically tell us the results. Just log onto the portal and put your results in no human contact, just like you were buying a test kit from amazon or cBS in the intervention arm. However, we did it slightly differently. We sent them the two testing kits and then we asked them to schedule an appointment, a zoom appointment and we watched them do the tests, we walk them through the tests, we help them build a prevention power plan and if positive, preliminary positive rather, we link them to care In Moxie was a very similar study. This was for transgender youth aged 15- 24 single, not in couples. And it was exactly the same design in the intervention on. We actually sent them a testing kit and we had a video chat with them in the country. I sent my testing kit and said tell us when you're done. So let's look about how about how we actually did this. So you can see here remember this is a research study. So we did all of us are recruitment by social media. So we recruited on things like instagram, facebook scruff grinder, bareback real time. All of these kind of sites with paid advertising, sometimes free advertising. So transgender youth or men in relationships would click on the banner advertisement. They do a screener to see if you're eligible completely. Baseline survey. And then they were randomized to one of the two arms. As I said in the control arm, we just send them a test and get and then they were on their own and then they self reported that press results in the intervention harm they we mail them to kids. And what's fundamentally different here is that they had a video check counseling session. Either has a couple if their nexus on there. Only three in boxing. And what's remarkable and I'm happy to share these papers with everyone is how much people loved this. This is a research today where 100 of people did exactly what you asked them to do. Everyone ordered a kid, everyone scheduled a session. Everyone reported the results and then the qualitative work afterwards we asked why did you do this and that because it was so easy, we didn't have to leave home, we didn't have to drive three hours to go and get tested. And I always point out to people, you know, you can just buy your own testing kit from, you know, amazon a CVS and do it on your own what I had again and again. It's been too scared to do it on my own. So people want a counselor to walk them through it, but they don't want to go to a place to get that service. And this is what telehealth can do. It's remarkable how the health can meet your client where they are our most common time for people to schedule. HIV testing was after 10 pm. Uh, you know, end of the day, people just wanted to do it. Then another significant group during lunch time. The number of counseling sessions I've done where I'm on video and they're sitting in their car during the lunch break at work during their HIV tests. But that's what people wanted to do. And this is a really good way of meeting your clients where they are. So we have another polling question coming up. Um, so how likely are you to consider implementing something like this and why you're answering that? I'm gonna go get back to the previous polling question where we ask you which of the patient outcomes of your greatest priority and lots of people most of your said retention in care. And I understand that particularly during a pandemic, when it's really hard to get people to come into services, retention in care is a big issue retaining people living with, living with HIV is a number one pathway towards viral suppression, create environment suppression is a huge part of any of the epidemic. And so it's clear that I'm going to talk to you or I can talk later about how we use telehealth to retain people in care. Telehealth visits. Don't have to, you know how long it can be a 30 42nd video chat. How are you doing? Do you have any problems? Little droppings like that shown to really rapidly improve retention in care. Okay. So I want to move along now and talk about some of the lessons with length along the way. Number one lesson. Keep it simple. And we know this. There's a real rising prep studies recently of prep studies that use telehealth to get a lot of more people onto prep because we know predators grade. We all have prepped. You know the uptake of prep is no way where it needs to be to end the epidemic. You can keep it simple by having different different modes of communication. You can use, you can do what we're doing now. You can do HIPPA compliant video software Zoo. You can just do zoom, you can do it by email, you do it by telephone calls. You can even do it by smS or text messages. If you ask your client, ask your patient, how do you want to communicate with me? If you put the power in their hands and you are much more likely to get good retention and uptake in your telehealth. Yeah. This is an interesting one. Laboratory testing people always think, well you're gonna have to come in for laboratory testing. Not always. I did another study that I didn't. You don't have to live on what I can talk about what we did S. D. I. Testing for male couples at home. We sent them testing it. They swap themselves. They sent it in, we tested it, we given the results and link them to go and give them counseling Again, you know? Um first of all we had 22 positivity which is really high because these men were not engaged in routine HIV testing just because it wasn't convenient and this is what telehealth can do. Telehealth is not a barrier to collecting specimens from people prep medicine delivery. Your provider can send your your prescription for prep to pharmacy. You can use sms or telehealth conversation to your pharmacy to arrange a pick up your service. It can all be done without having to meet anybody. Okay lets moving on to. Another lesson that I've learned through doing this is I have talked about this a lot already offer a broader array of services. We really we tend to kind of oversimplify telehealth and think of it as a doctor in a white cow talking to the client you know or a nurse or nurse practitioner. Yes, that is a big part of it. You can use telehealth for providing. Nature is one of the things that I think tell how this fundamental for his routine HIV testing, you know, the covid pandemic disproportionately affected communities of color, it disproportionately affected communities have that didn't have a lot of services to begin with. I've been in HIV testing and counseling for 100 years myself and I know that all of the community places that I tested closed down. Um and so you can do this, you can send people HIV testing kids to their home and ask them to create a schedule a time and do the test in. Uh I'll send you the script, I've written a script how to do it. It takes 20 minutes. It's easy, but it's all the other things that are interesting as well. You can do social care, you can do psycho educational resources, you can do prep screening, you can do behavioral counseling, basically those who might be struggling with addiction or substance use issues. You can still do that type of counseling via telehealth. There's some really interesting ones as well, like food pantries. We all assume we have to go for a food pantry. Well, you can use telehealth. If you can order groceries online, why can't you have online food pantries that deliver? I mean, it's not rocket science. We can do all this type of For your third polling question. I asked you to think about whether or not we use something like mocks your next is to do home HIV test. Uh, I'm really excited. About 53 of you said you were likely and those 53 and you can email me and I'll send you the script for the 23%. Who said you were unsure? Let's talk about this in the Q. And a session and let you know why you're unsure about using. Then the other lesson I want to leave you with moving forward is you need to provide a diverse number of interaction modalities. If you look at the bottom of this list here is the most common one. This is face to face. This is me getting on the bus and going to my doctor and seeing my daughter face to face. But there's other things you can do. You can use live video conference in just like we're doing now. You can use remote patient monitoring or a patient portal. It's kind of like a one stop shop where you can see everything in one place. You can use store and forward, which is basically the electronic transmission of health care information. Um We can talk about that more in the Q. And A. The take home message from. This is first of all, telehealth works telehealth. It does not need to be expensive. Um It does require a little bit more training. Uh We all know zoom fatigue. We have somebody because it's harder to talk to people because you've got to try a little bit harder. But it does require about training to make sure that people are using the appropriate language, physical and body language when they're talking to people. So this is how I want to end you. And into it was weird end today in summary. So in summary, broadly adopting telehealth nature. Erica has huge untapped potential. They can increase screening for HIV and STD's, they can improve the time list care. We don't want people sit in a way for the pandemic to be over before we go and get the routine testing or the linkage together. We can do that now through telehealth has a huge part to play in increasing access to prep and prep services. What I the reason I'm so passionate about telehealth is that there's so many barriers, structural barriers, stigma, discrimination, Transportation, economics. I live in the middle of a rural area where there's just no services, telehealth is not going to wipe those all the way. I'm not that naive, but it's going to help with a lot of those. The science is clear, it improves adherence and it reduces stigma buy and these are fundamental ending the epidemic. So I will leave you now in summary by saying clearly and I'm very excited about the whole, I believe it works. Um and I'll hand writer David, I look forward to your questions coming up soon. Thank you so much. Thanks so much rob. I thought you were channeling your inner tha knows for a second by saying you were going to end all of us and I have flashbacks to Avengers infinity one, you were going to snap your fingers. I have so many questions um, and I think to move us along uh, will actually go right into the workshops and we'll have time for the questions afterwards. Um, so to everyone who's watching, please click on the lower part of your screen to join the workshop sessions and we'll resume with the question and answer session with our esteemed panelists at about 2:00 or 2:05. All right, I want to welcome everyone back from the workshop sessions and thank you for joining us for what will be hopefully a very illuminating panel discussion with our two speakers, Doctors, Den Daci and Stevenson, and so I'll just jump right into it. Um we got a first question already coming to us and this can go to both of you and some of the research that you've done and one audience member wanted to know, does acceptance of telehealth very according to age, ethnicity or gender. Have you seen that in your in your research, doctor did not. You will start with you first know about dr Stevenson. Yeah, thank you for this question. Actually, this is what we thought that's gonna be like affected by age or race or but actually the factors that affected their acceptability for tell house where uh you for example, like there are certain factors related to the patient like being us born versus not or having like um for example, like previous, like how long standing they had HIV how difficulty they had attaining, like clinic visits, definitely that kind of increased it versus for example, if they are, they speak foreign language, it was less likely to want to do tell a house compared to in face visits. So there are several factors that kind of affected that and people who have high stigma also wanted to do tell a house compared to in phase as compared to in person visits. So these are the factors, but not so much the age and not so much the race. And the surprising for us is that the people that didn't have like a not achieving virus suppression, having difficulty taking their medication, but this didn't really affect whether they want to the house or not. Um So yeah. Okay, that's Stevenson. Yeah, good question. So my telehealth experiences mainly with HIV prevention to working with HIV negative populations and we saw no difference in acceptability by age, race, ethnicity, nationality. Anything what we do see is differences in how people interact with telehealth for example, uh younger people like under 18, they wanted to do HIV testing after 10 PM, 11 PM. Older people wanted to do it around six p.m. And so there was this uh, make sure that your telehealth has options so that everyone can join in and it's not restrictive, but we intend of acceptability and willingness. We really didn't see any differences. Okay. Yeah, it's interesting because when I was working at Morehouse School of Medicine, I remember conducting focus groups with students at the Atlanta University Center. So we're talking Morehouse College, Spelman College, um, Clark, Atlanta and Morehouse School of Medicine. And we were asking them about whether they would be interested in telehealth services and I thought to myself, okay, these are younger millennials, generation Z. And they're going to be all for it. And I was really astounded. I mean, obviously it's a small sample, but I remember a lot of them telling me well if it's mental health counseling, I would want to do telehealth. But a lot of them said surprisingly to me, at least, you know, I want a doctor or nurse practitioner p A. To touch me. If I have something going on like a rash, I want you to look at it, I want to feel that part of it. And so it was always interesting to me to see that and how my assumption was wrong with that. And I think a lot of us may make generalizations based on race, ethnicity or gender um and maybe completely off. All right, so let's switch the audience question number two, This is about dr Donati study um in the survey of people living with HIV about the likelihood of using telehealth. How was the idea of telehealth framed to the people for the study? Yeah, that's very good actually. We did some focus groups and some you know like trying to put like what would be the best sentence to explain it in the survey because most of these people didn't have experience would tell us before. And the way we said it is like a live video conferencing. Like if you have the ability to interact with your physician through video. Um And but there there will be no examination but just like through there, would you be willing to do that instead of coming to the clinic visits? And that's how we framed it? Mhm. Okay, good for that. Um I had another question I wanted to ask dr Stevenson about the studies that he did. What was the racial and ethnic background of the participants there? Because you know, when I first heard your results, I kept thinking to myself, are these kind of poor and what we're talking about racial inequities and medicine and how it disproportionately with covid 19 HIV falls on black and brown communities. I was thinking to myself, was it equally proportioned? Did you see more involvement for from if it was men who have sex with men, was a more white men than say black or latin? What did you see in your study? So we um in a project Moxie which is transgender youth aged 15-20 for we had I think 56 of our participants were transgender youth of color. And then in Nexus, which is male couples, around 45 of couples in which at least one was a man of colour. But what really matters is where you advertised the advertising on Facebook, you can get a lot of white people if you advertise on, you know, you get much more racial diversity diversity on instagram and on its knowing your community and working with your community to advertise in the right place. Okay. And men of color would include indigenous, asian, pacific islander latin as well as black. Okay, so we have a third question here from our audience and I want to remind everyone if you have a question you want to ask our two presenters. We have about 20 more minutes. So just click at the bottom of the screen of your submit button and we'll go ahead and forward uh the question on to us and we'll be able to answer it. But this is question number three and I'll read directly from what this audience member said, systemic barriers exist within Ryan white programs providing care to people living with HIV. That differs from state to state. What advocacy our providers, especially within the southern states, among people living with HIV, impacted by social determinants of health doing to address these gaps towards ending the HIV epidemic. Um, dr Stevenson, I'll start with you on this one. I saw you nodding your head as well as as the question was unrolling, what do you think this huge state differences in the distribution of the structural barriers to engagement in care? One of the things to both of my studies and most of my studies are national and one of the things that we have to grapple with is really simple things like I was that age of consent, there is so differently by state that we end up with like 12 different consent forms to to make sure that we're recruiting the right type of were legally recruiting new thing to us for this in terms of what providers can do. I think, uh, I think producing an array of telehealth options that meet the diverse needs of diverse communities, I think just setting up one zoo opportunity to click and federal resume is going to get you one type of user, one type one. You know, one community is going to have technological access when you telehealth modalities. You've got to think about, don't want to use SmS to argue something that's trapped based on using this video based, you've got to be as diaper. Your telehealth has got to be as diverse as your community that you're going to serve. And if you're not doing that, you're actually not going to surmount a lot of the barrier. I'm not sure if that answers your body. No, I think that's a great point. Dr linda. Did you have anything to say about that question? Um I think like this is a good question, but it has like really no simple answer for that. You know, many states are different in many ways, including like expansion of Medicaid, whether some states expanded or not, how many people are insured versus not then um also another big problem for example, like the legality, like criminalization of HIV and I think like what physicians can do also is be advocates and be part of these uh, you know, discussions and talks because you don't want people who are making these rules and laws have no uh you know, like uh really not based on science and based what we have. So um, so yeah, but but that's definitely not an easy kind of straightforward answer to like a solution for this because each state is very unique and very characteristic. Yeah, I would I would add on to that. I think that's a great point that I think, you know, I don't think anyone saying that telemedicine and telehealth is going to absolve the word of racism, Sexism, sexual prejudice against L. G. B. T. Q. Plus communities. And that telehealth I would argue would just be another venue by which someone if they're not trained properly or if they have a bias, it's just another venue by which they can exhibit their bias. One of the things I thought about when Dr Dean Daci was talking was that how we do have to get more involved with our local politics because one of the things that we'll see similar to how we see black and brown communities and communities that are underserved traditionally by medical facilities, um it's usually around transportation or access but would telehealth. We're going to see also literacy with computers. Um and with our elders as well, we're also going to see uh inequities and disparities in internet access availability of having sex phones. So I wanted to kind of add to that. Do you all have any suggestions of what you've done locally? Because I think locally we can work with politicians or higher politicians or lobby politicians to make sure that they get funding to make that more balance so the communities that don't have these computer access points or wifi, is there anything else we can be doing on those levels as telehealth expands either of you. So I think you're bringing a very good point because like we keep on saying that this could be like waste telehealth to expand um you know, health access to get in rural areas and then um you know population like minority population. But however we know that from data that actually like the manage population are less likely to own devices like a computers and laptops, maybe smartphones this gap degrees. But still for example rural areas they have much less um their own devices compared to their urban counterparts. And also not only that the broadband access right? So to increase access to internet when we talk about rural areas having difficulty accessing HIV care and coming transportation, but also they don't have internet that they could connect with their providers. So this gap still exists and we have to kind of keep on kind of advocating for increasing access to care and and to tell the house by increasing broadband connection and uh you know providing some support and some technical support for at least using these devices. I think we we tend to talk about broadband issues as a commercial policy or as a business policy. I think reframing equal access to technology and the internet as a health concern is a fundamental policy changes. Just like I argue with marriage equality, Marriage equality was always put forward as a social justice issue and it was but it's also a health issue and equal access to broadband technology is a health issue and I think it needs to be, the lens needs to be changed. The other thing that we don't do is some simple things like we have food printers, Why don't we have technology interest where people can like check out devices and actually use them to actually improve their health. You know, typical things like that are actually quite easy to do. Yeah, I think those are both amazing points. I just wanted to add that AIDS view just added HIV criminalization information to their website. So, if people want to visit the website, AIDS bu dot org, um they can check that out to see what the laws in your state and if you want to lobby against them, that obviously has implications for what we're talking about today. All right, question for I'll send to you dr Stevenson, will we be able to continue providing telehealth services to patients that move out of our jurisdictions but would like to continue receiving services from us. I'm talking specifically about prep services? Um I think so. I guess I should give you more an answer than I think so. So, in terms of like, I'm some my experiences from a research perspective, so my research, that is just from all 50 states and so there's no legal barrier to millions. Want an HIV testing care and doing a home HIV test kit from another state. The place it becomes tricky is if you want it to be a billable service, if you wanted to be a billable service, then I think there might be issues without having declines out state or whether or not. So the insurance companies need to, insurance companies, which I rarely defend. I've done a good job in the last 10 years making um, telehealth telemedicine and a billable service. But they do need to catch up and recognize that, you know, it can be done at distance. So if I want to move to California, I might actually want to keep my michigan doctor and that's okay. Networks need to be less local. He's one fan. Yeah. I think very similarly to how we're dealing with the covid 19 pandemic in real time. We're also dealing with the evolution of telehealth in real time and it kind of exponent when you said 9000% increase, I don't I forgot which one of you said that that over from like 19 92,019 to 2020 that was a 9000% increase. Like that's astronomical. And the infrastructure and the changes and the innovation that's needed to accompany that is going to be a slow process in developing. So I I think you're right in saying that um we got another question from someone in the audience, can you please explain in more detail what rpm involves? And I don't know whether rpm was a random distribution sampling maybe was the RDS that you were talking about? I think at the rpm like remote patient monitoring. What was it again, a remote patient monitoring. This is what I think because we we talked about this innovative, so that's like one modality of telehealth and if you wanted to have like the kind of uh more an example like in real life is the I. C. U. So what happens like so many like many facilities don't they don't have critical care for example positions in their facility. That's one example. And they have physicians and somewhere else just looking at their monitors, looking at their vital signs there. You know all these data in real time and providing instructions to a physician that is present locally but not interacting directly with the patients. So that's kind of one form after the house is called remote patient monitoring. Yeah. And I think that speaks of thanks for explaining that because I didn't I didn't even know there was an acronym for that. So when you explain that I was thinking myself okay what exactly is that? But I think it speaks also what dr Stevenson was saying earlier is that people traditionally think it's just a person in a white coat meeting with a patient and doing one on one patient care. And it's a slew of services um that are included under the umbrella of tele house. So we start we have to start explaining, and I think not only marketing but communicating this better to population. So they understand the menu of services that may be available to them. Um All right, we have another question here from the audience, are their templates available for developing telehealth protocols for starting and evaluating prep? Um and then I also, I was given a note to just mention that the toolkit that all the participants will receive after this program. So you all will receive a lot of the information and a lot of the resources that we have after the completion of this program. But again, that question for both of our speakers today, are there any templates available for how to develop telehealth protocols for starting and evaluating prep dr Donati. Yeah. So I don't want to speak about perhaps specifically, but I would say HIV care in general and perhaps there are how to implement the house of programs in general and there is like there are many articles and kind of uh studies out there about the implementation aspect of it. And there is also a telehealth network that you could go to and they have a lot of information and even a lot of uh legal uh legal requirements and like what are the rules in each specific estate? I could provide the website. That would be helpful if you put the website in the chat. That would be very helpful because I think people may be able to see it. And then we'll also provide that to everyone after conclusion of this. Um dr Stevenson. Any thoughts on that? Yeah, coming soon, I think next month is a new set of national guidelines on how to do home HIV testing and perhaps screening. Um I know that because I just wrote them uh and so what that's going to include is like how everything from, how do you uh how do you schedule appointments? How do you set up a safe, secure environment? Are you man? I'm testing kids And then the actual sprint, like in the 30 minute session, what we're saying more order, how do you link people to care? So all of that is coming soon. I will put my email in the chat now, but linked to it and you can access those. But there's also several private companies that you can look up that provide prep uh via telehealth. And so it's it's there and it's uh you'd be surprised so relatively easy. It is to do. Yeah I would I would add to that that there are also programs that are developing that are not so much provider centered with regards to prep and so they may be nurse led or pharmacists lead. And so I think in addition, you know we've been dealing with prep almost for a decade now um and it will be a decade in 2022. But I think as we move forward with it with the evolution of telehealth and then also how to provide different services. So it's not that traditional brick and mortar service, it doesn't have to be with a P. A. Or a nurse practitioner or a doctor. You can have interim visits with a peer navigator with someone else. I think telehealth folds neatly into those as we're evolving with this. So I think it will be tremendously helpful. Um And yeah if you can add to the chat that would be great. Dr Stevenson um And then we have one more question over here. What resources have you found to assist patients interested in telehealth but who may not have regular access to a smartphone, computer, tablet, internet or phone plan? Yeah that question um Dr Stevenson let's start with you. Dr don don? T go ahead. No. Uh yeah we don't have probably the resources but I will tell you like uh for example vaccine trial that we wanted to to put like a diary through smartphones because they have you know the resources to do that. They provided tablets and smartphone to the participants. So I think that this is not you know, not something unreasonable. When you talk about cost effective value of care. Like if you compare the price of providing like just a tablet or smartphone for a participant compared to all the other expenses of transportation and other things. It would be cost effective. But this is kind of one way that for example, other trials, not in real, you know, word case, but have you, have you done in order to overcome that? Okay. Yeah, a couple of things down to that. What's interesting that in mind, so I recruit online, I recruit thousands of people online for HIV prevention studies and so I'm working with the online community um what's which is has a slight selection bias. Those interesting that open to 20% of my samples have housing insecurity and that's always a surprising to feel like people are housing secure but they still have a smartphone. Smartphones are often the last thing to go because the vital ways of communicating. And so that's one thing to consider. I think we over emphasize the fact that a lot of people don't have access to technology. The other is um as for earlier and I agree with DR technology, I think we need to get better recognize and providing people with devices even through shared community resources such as technology banks, our libraries with private rooms. You cannot do HIV testing our lives because that's what you can't speak. But also it's not private but providing public spaces where people go in and use technology privately. That's what we need to do in. You know, you know, I work mostly in Detroit and the access to resources there massively limited and if we just set up these community technology banks, we could solve some of these problems. Yeah. Can I get one more thing also for what dr Simpson said, remind me of something about like shared, you know, community resources at the V. A. They are there, they are like they are advanced really and you tell a house and they have been using tell house for quite a while and what they do is that they don't provide each person with devices and uh you know uh personal, but there are these Seebach clinics where there are distributed across and not in major kind of urban areas where the participant can go to these specific like which is close to them instead of driving a long distance and connect to the provider to the HIV providers through these clinics in the syrup already there, so that could be like something that would make also like transportation and kept distance a little bit easier. Yeah, I think that's a great point. It's a lot of things that we already have, but it's just integrating the telehealth modalities into that. And I do think a lot of clinics, a lot of resources can write grants or include budgets in their funding. It's not about giving somebody a cell phone, but maybe helping them with services and seeing a smartphone as essential to health services in the future, so we can help them pay their monthly bill that will help them have access to the health services they need. So I think this is a great discussion about that. We're gonna be running out of time. So I'll probably make this the last question um from the audience. So I'll read it again. There are special considerations that are made in person for transgender persons accessing care. What have you seen if any that have been made in the telehealth spectrum? Actually, I start with this one. Um, so not much sadly. And what people, David kind of mentioned this earlier like telehealth is not the magic bullet because it's not the cure all because you can still be mean over telehealth, You can still reflect your biases and miss gender. Somebody over telehealth. Um, so what we saw one of the problems, I was HIV testing telehealth from, from the youth and we purposely did several things. We worked with transgender community on all of that advertising and all of that to understand where the physical and virtual venues are, we should do recruitment. Um, we all of my interventionist, my staff who, who ran this were members of the transgender community, which is an investment in the community. I'm not about studying the community and then just like running off with the data. And so this is what we need to do. We cannot just assume. We cannot just forget all of the cultural competency things that we do. And we often place attention on in person care. We often just let them go and like as long as the technology works will be okay. No, you've got to do things like having transgender culturally appropriate providers or have actually having transgender trained intervention. And that's what we did. And we are Yeah, I was transgender and gender diversity is really like this because it's like I was somebody on camera who understood my lived experience and they could talk me through. It wasn't I don't want to talk to some middle aged white guy like me and I have no idea what I'm talking about so that you've got to keep an eye on them. All right, That's a great idea. Dr Donati you had any extra thoughts on that? No, that was good. Okay. Um I'm gonna go to question nine but I'm gonna have us be real brief about this. And then I also want to mention people can find the National Health, the national telehealth Policy Resource Center. Um And I'm going to spell out the website, it's season cookie Season cookie H is and harry P as in paul CS and cookie A is an apple dot org. So again, it's C c h p c a dot org. So thank you dr Wendy aci for providing that resource for us. Um There are plans to incorporate, this is the final question. Um plans to incorporate a telehealth hub in our new supportive housing development for people living with HIV in austin texas. What advice do you have for us to make the most of this resource for the community? You can see me. I was actually smiling because that made me very excited to see both of you were like, oh my God, it's such a great idea. So what advice as to experts would you have to those people that are developing this to make the most out of that resource? I think it's a great idea. I mean, I didn't, you know, thought about it, but it just uh it could work and it just I think like asking the people, you know, like what's the idea about how to improve it? I think it's very important and having like focus groups and understanding that user's perspective. So it's better to come actually like any advice to come from the participants of the program rather from actually experts sitting in, you know, in our clinics, This is my thoughts. I think there's two or three really important things. You can do. One, as I mentioned this in representation is just think about having unconstrained access and people might want to do this at 10 11 PM. Uh And that's why I meet your client where they are. The other is we tend to when we set up these subs like you can use a little help but nothing else. This might be their only access to technology. So so you can use this the telehealth and you'll get an additional hour if you need to explore because you're looking online for other opportunities and things. You're providing people without access to technology. As I said, it's a vital health intervention. So making it synergistic. But yes, you can use the technology for health, you can use it for other things and just having it be as really available as possible. I would agree. And I just want to reiterate what dr don don't, you just said, don't make it where you're creating something, and then bringing it to the community and saying, oh, what do you think of this? The community has to be involved with the inception of the ideas at the table at the beginning, Not just for buying at a later point. Okay, so we're going to wrap things up now, and I want in 30 seconds each final thoughts or final messages to the people out here, listening that are engaged in telehealth are ready to start a telehealth platform or have experienced to it. So, we'll start with Dr Dean Daci. Any final thoughts about this, or any advice you would give? People who are involved in telehealth, particularly with people living with HIV. I think the house is here to stay, it's not going to go anyway. Uh and and I think the most important in the future is to find out who would benefit the most and how and how can we make it better experience for the participants and not the tells would not be for everyone. Um and patients need to share this kind of decision. Okay, dr Stevenson. Yeah, excuse me. I repeat one thing I said, make it as available as possible. People want to do this at all hours and not office hours, that's why it's convenient. Keep an eye on continuity in quality. You know, just as when I go to provide, I want to see the same person every time you still want to do that vital help. They want to see the same person every time and putting it online is not a reason to forget our principles of cultural competency and quality and echo everything I once said about making sure it's community home. Excellent. Okay. I want to remind the audience that you will receive a short follow up survey. So I want you to please complete the survey because your feedback will help us improve blueprints for success virtual training institutes as we move forward with this. In addition, you'll receive a certificate of attendance as well as a tool kit that includes key takeaways from the program and where to look for additional information. If you complete all four programs, you will receive a certificate of completion for attending the blueprints for Success Virtual Training Institute series. I want to thank Dr Dean Daci and Stevenson for joining us in providing their expertise and answering all the questions today. I want to thank Gilead for the sponsorship of this amazing initiative and thank you the audience for coming. We hope to see you at our final Institute training Institute and I just want to remind everyone. This is a series of four and this is the third of four. Our Final Training Institute will be on Tuesday june 8th and will focus on sustaining the urgency and ending the HIV epidemic. And we will have uh Gregorio Millette as well as Doctor Only Blackstock joining us. So it should be a very Wonderful discussion. So, again, thank you all for joining us and mark your calendars for June eight and join us. Then Take care. Thank you. Yeah. Created by
