An evaluation of telehealth services at New York City tuberculosis clinics throughout the COVID-19 pandemic

Abstract

In March 2020, three New York City (NYC) Department of Health and Mental Hygiene Tuberculosis (TB) clinics suspended most in-person services due to the COVID-19 pandemic and rapidly implemented telehealth to provide remote TB care. We conducted a prospective cohort study of patients with TB or latent TB infection (LTBI), who received treatment from TB clinics between April 2020 and December 2022, to compare telehealth and in-clinic services. To evaluate the success and breadth of the telehealth program, we compared patients who utilized telehealth with those who did not, analyzing differences in demographic characteristics and key outcomes, including utilization of telehealth, appointment completion, and treatment completion. "Telehealth patients" completed at least one scheduled telehealth visit during the study period. We conducted bivariate analyses comparing telehealth versus in-clinic patients. 56% (497/885) of patients with TB and 45% (954/2127) of patients with LTBI had a telehealth visit. Among patients with TB, no disparities in proportions of telehealth and in-clinic patients were observed for age (p = 0.31) or primary language spoken (p = 0.37). Among patients with LTBI, younger patients were more likely to use telehealth (p < 0.001). Using mixed-effects logistic regression models, the AOR of completing a telehealth visit was lower compared to in-clinic for patients with TB (0.77, CI:0.65-0.91). However, excluding April to June 2020, the AORs of completing a telehealth visit were comparable to an in-clinic visit for patients with TB (0.94, CI:0.77-1.14) and for patients with LTBI (0.96, CI:0.82-1.13). Among 641 patients with drug-susceptible TB, 95% (333/352) of telehealth patients completed treatment within one year compared to 88% (254/289) of in-clinic patients (p = 0.002). This result is limited to the descriptive summary of this study population. During the COVID-19 pandemic, NYC Health Department provided telehealth to many patients with TB and LTBI of diverse demographics, and telehealth services were mostly comparable to in-clinic services.

Fig 1. Flowchart of patients using NYC Health Department TB clinics telehealth services, April 2020 to December 2022.

^*TB: Tuberculosis ⁺LTBI: Latent tuberculosis infection. ‡ Telehealth patients: Patient telehealth utilization was categorized as having attended at least one scheduled telehealth visit or completing no telehealth visit.

Fig 2. Rolling 7-day average of completed in-clinic and telehealth visits by day, 2020-2022.

Fig 3. Monthly proportion of complete and incomplete visits of in-clinic and telehealth visits for patients with TB* and LTBI†, April 2020 to December 2022.

*TB: Tuberculosis †LTBI: Latent tuberculosis infection.