Wednesday, September 27, 2023
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Telemedicine useful for HIV treatment

Telemedicine, which involves consultation of patients by doctors remotely, is being used in many parts of India. A study has shown that it can be used for treatment of HIV patients as well. Anti-retroviral treatment of HIV-affected children through telemedicineis better than conventional method in terms of average cost, treatment compliance, follow up visit and number of patients treated.

The Paediatric Centre for Excellence for HIV care at Sion Hospital, Mumbai with the collaboration of UNICEF and National Health Mission established the Paediatric HIV Telemedicine Initiative in 2013. Some of the centres providing anti-retroviral therapy (ART) treatment were connected to the Mumbai centre through video links. This enabled expert opinion and services, nutritional counselling, care and treatment adherence motivation to HIV-infected children and adolescents easily.

For mid-term evaluation of the initiative, researchers selected three out of 35 telemedicine-based ART centres functioning in Maharashtra, and another three that were not linked with Mumbai via telemedicine link.

At the end of the two-year study period, the team reported that the per-visit cost in telemedicine linked centre was about Rs 1,803, while it was Rs 3,412 for conventional centres.

The most critical part of ART treatment is timeliness of the visit. Usually patients are required to revisit ART centres within 32 days of their first visit for subsequent check-up and prescriptions.

The study showed that that the timeliness of visit was better in the telemedicine-based treatment.

Overall, the success of ART centres can be computed based on the decrease in the loss to follow-up. Any person failing to access the ART services for three consecutive months after the first visit are accounted as loss to follow-up. There was 5% decrease in the loss to follow-up cases in the telemedicine-linked centres.

“In remote areas, doctors in ART centres are getting exposed to expert advice through telemedicine initiative. As it is done on a regular basis, it gives an opportunity to discuss the clinical significance of cases in depth. This has a large scope to improve access to advanced care for the rural population with less cost,” pointed out Sarit Kumar Rout, a member of the research team.

“Our findings will help policymakers to scale up these initiatives as it reduces the cost per visit. As a proof of concept, telemedicine linkage leads to improves compliance and reduces loss to follow up,” he said.

There are other cost studies undertaken in Indian condition but they did not provide a complete picture due to certain lacunae. For instance, a study in 2009 reported that average cost per patients for ART services was Rs 1,287.

It computed the cost of ART services without accounting for capital cost. Thus, the findings of the new study provide evidence needed for the expansion of telemedicine services in India, the researchers said.

Background: India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.

Methods: We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.
Results: The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.

Discussion and conclusion: The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.

Sarit Kumar Rout, Yashwant R Gabhale, Ambarish Dutta, Sudha Balakrishnan, Mamatha M Lala, Maninder Singh Setia, Khanindra Bhuyan, Mamta V Manglani

[link url=""]Down to Earth material[/link]

[link url=""]PLOS One abstract[/link]

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