Pre-exposure prophylaxis and telemedicine during coronavirus (COVID-19): a qualitative study of the experiences of health care professionals in Mexico
A. Cruz-Bañares
A # , A. Rojas-Carmona A # , S. Aguilera-Mijares A , A. Martínez-Dávalos A , S. Bautista-Arredondo A and H. Vermandere A *
A
Handling Editor: Matthew Hogben
Abstract
Telemedicine, which involves utilising technologies for remote health care delivery, proved useful to continue offering certain health services during the coronavirus disease 2019 (COVID-19) lockdown. However, the extent of its effectiveness in delivering pre-exposure prophylaxis services for HIV prevention remains underexplored from the viewpoint of health care providers. Therefore, this study aimed to assess the experiences of health care professionals in Mexico who utilised telemedicine for delivering pre-exposure prophylaxis services during the COVID-19 contingency.
A qualitative study was performed: 15 virtual interviews with health care professionals were conducted, transcribed and coded in ATLAS.ti.
The results indicate that telemedicine effectively mitigated COVID-19 exposure, facilitated users’ access to pre-exposure prophylaxis counselling, minimised waiting times and enhanced health care professionals’ perceived control during sessions. While implementing remote services, certain organisational challenges, which were somewhat latent before the pandemic, became more apparent: colleagues recognised the necessity for more formal communication channels to disseminate information effectively. Additionally, there was a recognised need for electronic patient files to streamline data-sharing processes. An optimal approach would involve a blend of face-to-face and virtual services, contingent upon the availability of essential infrastructure, well-defined implementation protocols and comprehensive training programs.
Telemedicine streamlined certain processes, garnered positive acceptance from healthcare professionals and holds promise as a valuable post-pandemic tool for improving retention among pre-exposure prophylaxis users.
Keywords: COVID-19, health care professionals, HIV, middle-income country, pre-exposure prophylaxis, prevention services, qualitative study, telemedicine.
References
1 UNAIDS. UNAIDS global AIDS update 2022. pp. 1–376. 2022. Available at https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-update_en.pdf [cited 22 January 2023]
2 UNAIDS. Prevailing against pandemics by putting people at the centre. pp. 1–92. 2020. Available at https://www.unaids.org/en/resources/documents/2020/prevailing-against-pandemics [cited 16 February 2023]
3 World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd edn. World Health Organization; 2016. Available at https://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf;jsessionid=3C3AD72B703D33EA8F093FD57D1CD79B?sequence=1
4 CENSIDA. 3er trimestre de 2022. Boletín de atención integral de personas con VIH. pp. 1–41. 2022. Available at https://www.gob.mx/cms/uploads/attachment/file/764470/BOLETIN_DAI_TERCER_TRIMESTRE_2022.pdf [cited 24 January 2023]
5 Secretaría de Salud. Sistema de vigilancia epidemiológica de VIH. Informe histórico de VIH 4to trimestre. 2023. Available at https://www.gob.mx/cms/uploads/attachment/file/828578/VIH_DVEET_4toTrim_2022.pdf [cited 20 September 2023]
6 Veloso VG, Cáceres CF, Hoagland B, Moreira RI, Vega-Ramírez H, Konda KA, et al. Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study. Lancet HIV 2023; 10(2): e84-e96.
| Crossref | Google Scholar | PubMed |
7 Konda KA, Torres TS, Mariño G, Ramos A, Moreira RI, Leite IC, et al. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. J Int AIDS Soc 2022; 25(S5): 25974.
| Crossref | Google Scholar |
8 Touger R, Wood BR. A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP). Curr HIV/AIDS Rep 2019; 16(1): 113-119.
| Crossref | Google Scholar |
9 World Health Organization. Telemedicine. Opportunities and developments in Member States. Global observatory for eHealth series – Volume 2. 2010. Available at https://www.afro.who.int/publications/telemedicine-opportunities-and-developments-member-state
10 Monraz-Pérez S, Pacheco-López A, Castorena-Maldonado A, Benítez-Pérez RE, Thirión-Romero I, Carmen López-Estrada Ed, et al. Telemedicina durante la pandemia por COVID-19. Neumol Cir Torax 2021; 80(2): 132-140.
| Crossref | Google Scholar |
11 Lovo J. Telemedicina: Oportunidades en atención primaria. Rev Bras Med Fam Comunidade 2021; 16(43): 2552.
| Crossref | Google Scholar |
12 Rao D, Frey S, Ramaiya M. eHealth for stigma reduction efforts designed to improve engagement in care for people living with HIV. Curr HIV/AIDS Rep 2018; 15(6): 397-402.
| Crossref | Google Scholar |
13 Siegler AJ, Steehler K, Sales JM, Krakower DS. A review of HIV pre-exposure prophylaxis streamlining strategies. Curr HIV/AIDS Rep 2020; 17(6): 643-653.
| Crossref | Google Scholar |
14 Hoagland B, Torres TS, Bezerra DRB, Benedetti M, Pimenta C, Veloso VG, et al. High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil. Braz J Infect Dis 2021; 25(1): 101037.
| Crossref | Google Scholar |
15 Rosen JG, Zhang L, Pelaez D, Coleman JS, To C, Cooper L, et al. Provider perspectives on HIV pre-exposure prophylaxis service disruptions and adaptations during the COVID-19 pandemic in Baltimore, Maryland: a qualitative study. AIDS Patient Care STDS 2022; 36(8): 313-320.
| Crossref | Google Scholar | PubMed |
16 Üsküp DK, Nieto O, Rosenberg-Carlson E, Lee S-J, Milburn NG, Brooks RA. Acceptability and appropriateness of digital PrEP interventions for Black and Latina Cisgender women: perspectives from service providers in Los Angeles County. J Acquir Immune Defic Syndr 2022; 90(S1): S134-S140.
| Crossref | Google Scholar | PubMed |
17 Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res 2017; 17(1): 88.
| Crossref | Google Scholar |
18 Grove SK, Gray JR. Investigación en enfermería: Desarrollo de la práctica enfermera basada en evidencia. 7th edn. Elsevier Health Sciences; 2019. Available at https://scielo.isciii.es/scielo.php?pid=S1988-348X2019000200006&script=sci_arttext&tlng=en [cited 16 February 2023]
19 Taylor SJ, Bogdan R. Introducción a los métodos cualitativos de investigación. Vol. 1. Barcelona: John Wiley & Sons; 2015. Available at http://chamilo.cut.edu.mx:8080/chamilo/courses/MODELOSDEINVESTIGACIONII2019III/document/libro_metodo_de_investigacion.pdf [cited 16 February 2023]
20 Instituto Nacional de Estadística y Geografía. Disponibilidad y uso de TIC. 2020. Available at https://www.inegi.org.mx/temas/ticshogares/ [cited 21 February 2023]
21 Hoagland B, Torres TS, Bezerra DRB, Geraldo K, Pimenta C, Veloso VG, et al. Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil. Braz J Infect Dis 2020; 24(4): 360-364.
| Crossref | Google Scholar |
22 Zhu L, Jiang X, Cao J. Factors affecting continuance intention in non-face-to-face telemedicine services: trust typology and privacy concern perspectives. Healthcare 2023; 11(3): 374.
| Crossref | Google Scholar | PubMed |
23 Kichloo A, Albosta M, Dettloff K, Wani F, El-Amir Z, Singh J, et al. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Fam Med Community Health 2020; 8(3): e000530.
| Crossref | Google Scholar | PubMed |
24 Valerio AN. Application of blended care as a mechanism of action in the construction of digital therapeutics. einstein 2020; 18: eMD5640.
| Crossref | Google Scholar |
25 Blanch Andreu J, Cáceres Taladriz C, Nomdedeu M, Rousaud Pares A, Gómez Aguilera E, García F. Telemedicina y VIH. UOC Papers. Revista sobre la sociedad del conocimiento 2007; 4: 24-31 Available at http://www.redalyc.org/articulo.oa?id=79000408.
| Google Scholar |
26 Liu J, Liu S, Zheng T, Bi Y. Physicians’ perspectives of telemedicine during the COVID-19 pandemic in China: qualitative survey study. JMIR Med Inform 2021; 9(6): e26463.
| Crossref | Google Scholar | PubMed |
27 Reconde-Suárez D, de los Angeles Peña-Figueredo M. Regularidades teóricas de los protocolos de actuación de enfermería como resultado científico enfermero. Revista ENE de Enfermería; 2019. Available at https://scielo.isciii.es/scielo.php?pid=S1988-348X2019000200006&script=sci_arttext&tlng=en [cited 21 February 2023]
28 Ancha S, González Mesa Y, Javier F, Mérida M. Guía para la elaboración de protocolos. 2011. Available at http://www.index-f.com/lascasas/lascasas.php [cited 21 February 2023]
29 Freed J, Lowe C, Flodgren G, Binks R, Doughty K, Kolsi J. Telemedicine: is it really worth it? A perspective from evidence and experience. BMJ Health Care Inform 2018; 25(1): 14-18.
| Crossref | Google Scholar |
30 Alboraie M, Abdalgaber M, Youssef N, Moaz I, Abdeen N, Abosheaishaa HM, et al. Healthcare providers’ perspective about the use of telemedicine in Egypt: a national survey. Int J Telemed Appl 2022; 2022: 3811068.
| Crossref | Google Scholar |
31 Guma J, Klimowich K, Pan J, Collins P, Cooley D. Physician perceptions of stress and telemedicine. Osteopathic Fam Phys 2021; 13: 9-16.
| Crossref | Google Scholar |
