Variation in subsequent viral load testing and outcomes by visit type patterns in the first year of the COVID-19 pandemic at a large academic medical center in North Carolina

While telehealth was widely used to provide human immunodeficiency virus (HIV) care during the coronavirus disease 2019 (COVID-19) pandemic, research evaluating viral suppression by visit type is conflicting. This study assessed variation in viral load (VL) testing and outcomes by visit type for routine HIV care visits among people living with HIV (PWH) at a large academic health center in central North Carolina (NC). Electronic health records (EHRs) data from the Duke University Infectious Disease (ID) Clinic in NC were extracted in aggregated form. Pearson's Chi-square (χ²) tests were used to examine variation in VL testing and virologic suppression (VS) in 2022 by visit type patterns in the first year of the pandemic. Tipping point (TP) sensitivity analyses were conducted. EHR data from 1,835 PWH were included. Between March 16, 2020 and March 15, 2021, 53% of PWH received in-person HIV care only, 32% received a combination of telehealth and in-person care, and 15% received telehealth care only. About 20% of PWH did not have any VL test recorded in 2022. Among PWH with a VL test, 90% were virologically suppressed at all tests in 2022. Visit type was significantly associated with VL testing (P<0.001). The proportion of people who had no VL test in 2022 was larger among telehealth only users (31%) as compared to in-person only or PWH who received a combination (19% and 18%, respectively). VS in 2022 did not differ by visit type pattern in the first year of the pandemic (P=0.36) among PWH with a VL test in 2022. TP analyses identified that the proportion of unsuppressed VL tests among PWH without any VL test in 2022 would need to be multiplied by 2.1 to result in a statistically significant difference in VS by visit type (P=0.045). Our findings indicate that VL outcomes among telehealth users who had VL testing results documented in EHR at least one year later did not differ from in-person HIV care users. However, VL testing uptake was lower among telehealth only users suggesting the need for strategies such as remote VL testing to ensure regular VL testing among PWH who use telehealth HIV care.