A comparative study of transgender women accessing HIV testing via face-to-face and telemedicine services in Chiang Mai, Thailand during the COVID-19 pandemic and their risk of being HIV-positive

BACKGROUND

Due to the restricted availability of health services in Thailand, there are still some transgender women (TGW) who do not have access to HIV counseling and testing. Telehealth, which is accessible to individuals who are reluctant to undergo face-to-face interviewing, played an especially important role during the COVID-19 epidemic. The objectives of this study are to compare the characteristics, pattern of accessing HIV testing, and the HIV-positive rates of TGW between the face-to-face and telemedicine services.

METHODS

We conducted a cross-sectional study to compare the access to HIV testing and the HIV-positive rates among TGW via face-to-face service and telemedicine services and examined the influence of potential associated factors on the risk of being HIV-positive.

RESULTS

Of the 637 TGW participants, 26 (4.1%) were HIV-positive. Accessing the telemedicine service increased in the third and fourth COVID-19 waves (28.1% in the first and second vs. 71.9% in the third and fourth). There was no difference in the risk of being HIV-positive between the types of service. Having sex work experience (adjusted odds ratio (aOR) = 5.92; 95% confidence interval (CI): 1.57-22.30) and either never having been or tested more than 1 year ago were independently significantly associated with a higher risk of being HIV-positive (aOR = 4.05; 95% CI: 1.11-14.77).

CONCLUSION

The telemedicine service became more popular among TGW during the COVID-19 pandemic and was not related to a higher risk of being HIV-positive. Moreover, it proved to be an effective alternative channel to access HIV testing, especially for intravenous drug users. Sex work experience and irregular HIV testing are key risk factors for HIV infection in TGW seeking either the telemedicine or face-to-face service.

Design of a Service for the Management of Heart Failure Patients Using Telemedicine

The tremendous prevalence and mortality of heart failure (HF), along with the social and economic impact of its consequences, make an appropriate disease management utmost important. In this context, telemedicine offers promising possibilities. Current clinical guidelines and technological solutions do not address the problem of monitoring at-risk patients and patients affected by mild HF for prevention purposes. The goal of this work is to design a service based on a telemedicine framework for the management of heart failure patients. The proposed service grounds the monitoring of the patient on a custom multi-sensor array that we designed and developed for the purpose. The description of the processes involved in the service was carried out by means of Process Modelling tools, and in particular through Swim Lane Activity Diagrams. The results look promising for the implementation of the service in a real-life scenario. The main strength of the service resides in a) the use of noninvasive monitoring technologies to include patients with a mild HF or at-risk patients; and b) the integration of hospital and territory services to grant continuity and coherence in the treatment.

Assessing the telemedicine acceptance for adults in Brazil

PURPOSE

This study aimed to find factors influencing the acceptance of telemedicine for adults in Brazil. Moreover, it investigates the moderating role of disease complexity and the generational digital divide phenomenon on the intention to use the telemedicine service.

DESIGN/METHODOLOGY/APPROACH

A quasi-experiment was employed. Primary data were collected using a survey research method considering two different scenarios based on disease complexity and symptom severity. A total of 248 responses were collected using a structured questionnaire. The authors also tested these two scenarios in three generations (X, Y and Z) of adults. Partial least squares structural equation modeling (PLS-SEM) was used to analyze the collected data and test the research hypotheses.

FINDINGS

The results indicated that performance expectancy and perceived security and reliability are two predictors of the behavioral intention to use telemedicine, whereas effort expectancy and social influence showed no statistical significance. Furthermore, the results demonstrated that adults tend to adopt telemedicine regardless of the level of disease complexity. Finally, this study does not support the existence of a digital divide in the three generations.

ORIGINALITY/VALUE

The study applies the UTAUT model to assess the telemedicine acceptance for younger generations. It examines patient risk perception (security and reliability) as one antecedent of telemedicine acceptance.

How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on - an exploratory study

Background

Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform.

Methods

This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making.

Results

With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year).

PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service.

Conclusion

The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa.

Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.