Table 1.

Potential questions and areas of study to inform future usage of telemedicine in HIV clinical care

Questions	Comments and examples
Patient-focused factors
What does the patient prefer?	• Clinics should tailor the implementation of telehealth to their specific patient population, organizational structure, and location. • Which patients prefer video visits, telephone visits, or in-person visits?
Is the quality of care when primarily using telemedicine equivalent to traditional in-person care? How can the quality of care be ensured and optimized?	• More data regarding outcomes, including HIV-specific outcomes, such as viral suppression rates, and primary care outcomes, such as vaccination or cancer screening rates, are needed. • What is missed with a video visit? • What is the best way to ensure laboratory work or STI testing is completed? If laboratory work is ordered during a video visit, how can we ensure the patient is not billed twice (i.e., with a facility fee)?
Which clinical indications for a visit should absolutely be in-person?	• Mgbako et al. suggest in-person visits be prioritized for individuals newly diagnosed with HIV, new to the clinic, who are non-English-speaking, with limited access to technology, or with low health or technology literacy. • Patients with symptoms requiring a hands-on physical exam should be seen in-person. • Is there a best balance between frequency of video versus in-person visits for routine care of an asymptomatic individual?
Which patients are able to successfully engage in care via telemedicine? How do we prevent the new telemedicine era from excluding certain individuals?	• Which barriers are overcome by telemedicine, such as transportation or stigma, and which barriers remain or are exacerbated? • Who is not engaging in telemedicine, and why not? • How can we ensure all have access to a device and broadband connection and that those with limited English proficiency, vision, hearing, or cognitive impairment are not excluded?
Provider-related factors
Do providers feel comfortable performing video visits?	• What resources will empower providers to feel more confident with telemedicine visits?
What are the best practices for telemedicine? How do we teach this and incorporate it into medical school and training programs?	• How can training regarding telemedicine best practices be incorporated into medical school and post-graduate training so that providers entering the workforce are comfortable with this modality?
Patient-provider interactions
Are patient-provider relationships more impersonal with telemedicine?	• How do patients feel about the care they receive via video-visit? • Are patients more or less likely to stay with the same provider or clinic, and does the level of trust in their providers change?
Do video visits increase provider implicit bias?	• Are implicit biases elicited by visualizing a patient’s living environment? • Are some individuals being offered or not offered video visits simply because of demographic factors, like age or language?
Telemedicine logistics and clinic operations
What is the added burden on clinics as a whole? How can clinics maximize efficiency while ensuring universal access to high-quality care via video visits?	• How can clinic flow (i.e., templating, check-in and check-out processes, space, and resource allocation) be streamlined for telemedicine? • How can we maximize the patient experience while minimizing administrative and operational requirements?
Can wrap-around services for HIV be successfully delivered through telemedicine?	• How do we bring team-based care, central to Ryan White clinics, to the telemedicine platform?