HIV Virtual Pathways

Wednesday 29th June 2022

Dr. John Thornhill
Consultant @ Barts Health
Senior Lecturer @ Queen Mary University of London
 Three phases of COVID-19 pandemic and demand for virtual/telehealth services

Wosik J, et al. J Am Med Inform Assoc. 2020; 27: 957–962.

What are Virtual Services ?
• Virtual refers to any non-face-to-face consultation, namely by
telephone, email or video.

Other good practice guidance for remote consultations:

• General Medical Council. Remote consultations. 2021.

- Available at: https://www.gmc- uk.org/ethical-guidance/ethical-hub/remote-consultations

• Royal College of Physicians. Effective remote consultations.

• - Available at: https://www.rcplondon.ac.uk/education-practice/courses/effective-remote-consultations
 There has been a sudden and substantial fall in the number of face-to-face
consultations and a rise in virtual consultations

Slide credit: BASHH COVID-19 Sexual Health ‘Clinical Thermometer’ Survey Round 3 Results Snapshot (September 2020)
BHIVA Rapid Guidance for
Virtual HIV Care
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Resources and infrastructure

4. Privacy and confidentiality

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.
Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 Patient choice should be at the centre of HIV
clinical care
Semi-structured interviews in a UK HIV clinic and two HIV centres exploring the perceived needs of people with
HIV (n=13) and the relationship with processes of care.
Minimal illness/symptom Higher symptom/ illness

Some images from Noun Project.

Nixon E, et al. HIV Med 2015;16 (Suppl 2):Abstract 185.
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Privacy and confidentiality

4. Resources and infrastructure

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.
Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Resources and infrastructure

4. Privacy and confidentiality

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.
Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Resources and infrastructure

4. Privacy and confidentiality

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.
Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 Privacy and confidentiality

The following should be addressed at the start of a virtual consultation:

• Right person – confirm the identity of the patient (name, date of birth).
• Right time – is it convenient to talk? Is the patient alone and safe?
• Right place – check the person’s location and contact details.

• Clarify that if you are disconnected you will contact them.

• Guidance for safe enquiry about domestic abuse in virtual
consultations has been produced [17].
Safe Lives, Royal College of Obstetricians & Gynaecologists, IRISi, Against Violence and Abuse, Agenda, Standing Together, Women’s Trust, Women’s Aid, My CWA, Respect. Five Rs of asking about domestic abuse. Available at:
https://safelives.org.uk/sites/default/files/resources/Domestic%20abuse%20guidance%20for% 20virtual%20health%20settings-%20C19.pdf (accessed March 2021).
 Privacy and confidentiality

The following should be addressed at the start of a virtual consultation:

• Right person – confirm the identity of the patient (name, date of birth).
• Right time – is it convenient to talk? Is the patient alone and safe?
• Right place – check the person’s location and contact details.

• Clarify that if you are disconnected you will contact them.

• Guidance for safe enquiry about domestic abuse in virtual
consultations has been produced [17].
Safe Lives, Royal College of Obstetricians & Gynaecologists, IRISi, Against Violence and Abuse, Agenda, Standing Together, Women’s Trust, Women’s Aid, My CWA, Respect. Five Rs of asking about domestic abuse. Available at:
https://safelives.org.uk/sites/default/files/resources/Domestic%20abuse%20guidance%20for% 20virtual%20health%20settings-%20C19.pdf (accessed March 2021).
 Privacy and confidentiality

The following should be addressed at the start of a virtual consultation:

• Right person – confirm the identity of the patient (name, date of birth).
• Right time – is it convenient to talk? Is the patient alone and safe?
• Right place – check the person’s location and contact details.

• Clarify that if you are disconnected you will contact them.

• Guidance for safe enquiry about domestic abuse in virtual
consultations has been produced [17].
Safe Lives, Royal College of Obstetricians & Gynaecologists, IRISi, Against Violence and Abuse, Agenda, Standing Together, Women’s Trust, Women’s Aid, My CWA, Respect. Five Rs of asking about domestic abuse. Available at:
https://safelives.org.uk/sites/default/files/resources/Domestic%20abuse%20guidance%20for% 20virtual%20health%20settings-%20C19.pdf (accessed March 2021).
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Resources and infrastructure

4. Privacy and confidentiality

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.

Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 Considerations for an effective virtual
consultation
1. Patient Choice

2. Equity of access

3. Privacy and confidentiality

4. Resources and infrastructure

5. The healthcare relationship

6. Consideration for clinical staff in training

List not intended to be exhaustive.

Adapted from The Health Foundation; Three key quality considerations for remote consultations. http://www.health.org.uk/news-and-comment/blogs/three-key-quality-considerations-for-remote-consultations . (Accessed April 2021).
 HIV-specific hurdles in the virtual world
Virtual strategies for ART: Options for HIV VL testing and
 Start ensuring patient safety will
 Monitoring need to be addressed
 Switch

Logistic considerations:
Communication barriers:
 Blood monitoring
 Access to language line
 STI screening
 Being ‘understood’ where
 Vaccinations
English is not first language
 Medication delivery

List not intended to be exhaustive.

Expert opinion of presenter.
STI, sexually transmitted infection; VL, viral load.
 HIV-specific considerations in the virtual
world
• Within HIV virtual pathways every opportunity should be
taken to ‘make every contact count’ and to maximise the
value of face-to-face contact when it occurs1.

• For example, where it is feasible to do so, blood monitoring

appointments could be expanded to include basic health
promotion, domestic abuse screening, vaccination and
provision of pre-appointment questionnaires where
appropriate.

• Clinics must also provide clear information for patients about where to seek emergency
advice and support.
1. Public Health England, NHS England, Health Education England. Making Every Contact Count (MECC): consensus statement. 2016. Available at:
https://www.england.nhs.uk/wp- content/uploads/2016/04/making-every-contact-count.pdf (accessed April 2021).
Patient Safety
• Patient safety - Ensuring patient safety should be the overriding principle when considering a virtual versus
a face-to-face consultation. For example, is monitoring, imaging or examination needed that requires a face-
to-face consultation?

• Based on the health domains included in the

European AIDS Clinical Society guidelines2, a
follow-up framework was recently proposed:
• 13 procedures (such as blood collection) require
a face-to-face consultation and 13 assessments
(such as medication reconciliation and patient-
reported outcomes) can be carried out by
virtual consultation3

1. Public Health England, NHS England, Health Education England. Making Every Contact Count (MECC): consensus statement. 2016. Available at:
https://www.england.nhs.uk/wp- content/uploads/2016/04/making-every-contact-count.pdf (accessed April 2021).
2. . EACS Guidelines 2020 https://eacs.sanfordguide.com/ (accessed 5th Oct 2021)
3. Guaraldi G et al. HIV Care Models During the COVID-19 Era, Clinical Infectious Diseases, 2021,  https://doi.org/10.1093/cid/ciaa1864
 Contact Details

john.thornhill2@nhs.net

@JohnPThornhill