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. 2025 Jan;26(1):44-69.
doi: 10.1111/hiv.13701. Epub 2024 Sep 17.

Virtual care pathways for people living with HIV: A mixed-methods systematic review

Hamzah Z Farooq  1   2   3   4   5 , Louise Whitton  1   2   3 , Chikondi Mwendera  1   2   3 , Pip Divall  6 , Sophie J I M Spitters  1   7 , Jane Anderson  1   2   3 , John P Thornhill  1   2   3
Affiliations

Virtual care pathways for people living with HIV: A mixed-methods systematic review

Hamzah Z Farooq et al. HIV Med. 2025 Jan.

Abstract

Background: The COVID-19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored-approaches, especially for marginalized populations.

Methods: A mixed-methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two-way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle-Ottawa score and Stenfors' framework.

Results: Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID-19 while others were as part of trials.

Conclusions: VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a 'gold standard' for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings.

Keywords: HIV; antiretrovirals; gender equity; global health; inclusion; telemedicine; virtual care.

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Conflict of interest statement

HZF has received travel grants and honoraria from Janssen‐Cilag; travel grants from Gilead Sciences, ViiV Healthcare Ltd, European Society of Clinical Virology, British HIV Association and the European AIDS Clinical Society. JPT has received speaker fees from Gilead Sciences, and conference registration fees from ViiV healthcare. In October 2023, JPT became a paid employee of ViiV healthcare.

Figures

FIGURE 1
FIGURE 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) diagram of systematic review screening process [11]. Further information: http://www.prisma‐statement.org/. ARV, antiretroviral; MDT, multidisciplinary team; PEP, post‐exposure prophylaxis.
FIGURE 2
FIGURE 2
(a) Types and number of studies included in the systematic review and (b) types of participants of primary focus of included HIV virtual care studies. PLHCV, person/people living with hepatitis C; PLHIV, person/people living with HIV.
FIGURE 3
FIGURE 3
Map of location of all included studies. Greyed‐out sections indicate that no included studies were conducted in these countries.
FIGURE 4
FIGURE 4
(a) Primary mode of system for virtual care consultation of included studies and (b) alternate mode of system for virtual care consultation of included studies.
FIGURE 5
FIGURE 5
Designation of healthcare professional leading the consultation in the included studies.
See this image and copyright information in PMC

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