Date of Award

Summer 2023

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Jan Ostermann


Background: To maintain HIV care continuity during the COVID-19 pandemic, most HIV care facilities in the United States adopted telehealth. However, not everyone was participating in telehealth equally. This dissertation seeks to understand experiences with and the use of telehealth in HIV care, and decision processes guiding the selection of visit type during the COVID-19 pandemic.

Methods: Qualitative interviews explored people living with HIV’s (PWH) and HIV care provider’s experiences with telehealth HIV care and visit type decision processes. Quantitative analyses of electronic health record (EHR) data characterized patterns of and disparities in telehealth HIV care during the COVID-19 pandemic.

Results: Qualitative interviews showed that most interviewees had used telehealth and were willing to use or (re-)consider telehealth HIV care in the future. Reported telehealth barriers were related to technology, the virtual nature of telehealth visits, administration, and the socio-demographic profile of PWH. Visit type decisions considered patient-related, clinical, and provider-related decision criteria, and HIV care continuity. Providers suggested that telehealth is most suitable for routine HIV care encounters and established PWH who are clinically stable and generally healthy.

Quantitative EHR analyses showed that telehealth use in HIV care was highest in the first months of the pandemic and decreased afterwards. Telehealth was used by 47% of PWH in North Carolina in the first year of the pandemic.

EHR analyses between March 2021 and March 2023 found that 5% of PWH had a telehealth visit in South Carolina. PWH who are 50 years or older (odds ratio 0.59, 95% confidence interval [0.40,0.86]) and non-Hispanic Black PWH (odds ratio 0.58, 95% confidence interval [0.37,0.92]) were less likely to receive telehealth HIV care services.

Conclusions: Telehealth in HIV care was useful to bridge in-person HIV care interruptions during the pandemic and is ‘here to stay’; however, it may not yet be suitable for all PWH and all care encounters. To guide the optimal integration of telehealth in HIV care and promote equitable HIV care in the future, efforts to address persistent barriers to telehealth and shared decision-making to select visit types are needed.


© 2023, Valerie Yelverton

Available for download on Sunday, August 31, 2025