HIV Specialist - March 2021 - 28

TELEMEDICINE IN THE DEEP SOUTH
Equity in telemedicine in the South, particularly in rural areas, is not
there yet. While in some ways telemedicine takes away barriers like
transportation, time away from work, needing to go to a clinic where
one might see a nosy neighbor and get outed, plenty of our patients do
not have minutes or data plans on their phones or devices capable of
doing video calls, and broadband access remains a critical issue.
Adapting to the challenges of COVID-19
has required flexibility, innovation, dedication, and grit from our organization and
clinic team members. From the beginning, it
was clear that two absolute priorities had to
be met: we had to do everything we could to
keep patients and team members safe, while
simultaneously continuing to provide the
highest quality care to our patients living with
and at risk for HIV. MAO was fortunate to
have a robust telemedicine system in place,
and a dedicated team of individuals with vast
experience realizing innovative solutions
to the challenges and obstacles time threw
in their direction on MAO's journey to its
current holistic care model. This meant, from
the very beginning of the pandemic, we were
able to see routine and follow-up patients
safely via telemedicine, with both patient and
provider at home, while seeing new patients
and those with more acute needs in the clinic.
This kept the volume of patients in the clinic
area at the same time much lower. Initially,
we had the majority of our team working in
rotation from home on a day-to-day basis.
However, once we identified solutions to the
problem of consistently having the PPE we
needed, had a clearer sense of how COVID-19
was spreading, and how to keep the people in
our environment safe, most team members
were able to return to their in person day-today roles while continuing to provide routine
follow-up visits to patients via telemedicine.
Of course, we were still adhering strictly to
public safety guidelines, checking temperatures, etc.; we did not initially have access to
COVID-19 rapid tests.
Today, we rapid test all staff for COVID-19
weekly. All patients and visitors with access to
the building for more than fifteen minutes are
also tested. With mandatory masking, physical distancing, escorting patients directly to
exam rooms versus allowing them to cluster
in waiting rooms, robust symptom screens,
and contact tracing, we think we are safer in

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MARCH 2021

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the clinic buildings at MAO than at a supermarket or a coffee shop.
We did see an initial increase in patients returning to care, as did
many HIV clinics. There were certainly patients motivated to resume
taking medications due to fears about COVID. Thankfully, we have
been able to retain those patients in care and help them become virally suppressed this past year. Overall, our patients have really appreciated the ability to see us via telemedicine when they need to while
still having us available in the office for emergencies. Many patients
who previously felt hesitant about telemedicine have embraced the
technology, the convenience it offers, and, for many, the cost-savings
associated with travel.
Our staff and patient population have been hit hard with
COVID-19. While we are proud to say, thus far, we have had no transmission of COVID-19 in our clinic facilities as we can tell due to our
safety precautions and contact tracing, we have had members of our
community get sick. Most tragically, one of our nurse practitioners,
Dr. Angela Lowery, died from COVID-19-related factors in the fall of
2020, only months after her sister had also died from COVID-19. Our
staff and her patients continue to grieve, and, of course, it's challenging to fully process this loss as we continue the go, go, go of pandemic-shrouded clinic life. Helping our patients and colleagues through
their grief over screens, avoiding hugs or hand-holding, wiping tears
with masks on-it has all been a struggle. As a doctor, the Medical
Director, and as a parent, I think everyone who works for MAO does
so because of a deep investment in caring for our patients and people
in general. Showing that care with masks on and physically social
distancing is just different.
Equity in telemedicine in the South, particularly in rural areas, is
not there yet. While in some ways telemedicine takes away barriers
like transportation, time away from work, needing to go to a clinic
where one might see a nosy neighbor and get outed, plenty of our
patients do not have minutes or data plans on their phones or devices
capable of doing video calls, and broadband access remains a critical
issue. We have been able to fill in gaps with phone visits for many
patients for whom video visits are not possible or add barriers. While
this has taken some getting used to, I think we're all getting more comfortable with this care from a distance approach for stable follow up
visits. With that said, we are all in agreement that even the most stable
patient needs an in-person visit annually. Our patients with the most
barriers to care including through telemedicine are the ones whose
communities have also been devastated by COVID-19. Telemedicine
can help expand access, but fighting against the systemic racism,
poverty, and injustice that devastate our patients' health requires
multiple tools and resources. Right now, we persevere with whatever
tools we can get our gloved and Purelled ® hands on.


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HIV Specialist - March 2021

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