Over one million people in the United States (U.S.) are living with HIV. People living with HIV in the rural South experience delayed HIV treatment and increased mortality risks. Access challenges and HIV stigma exacerbate care disengagement for rural people living with HIV (PLH). This study examines the applicability and feasibility of telehealth to provide HIV care for older adults in the rural U.S. South. Semi-structured interviews were conducted with 27 key informants with expertise in HIV care and community engagement in high rural HIV burden states. Results indicate that telehealth challenges exist for older rural PLH to receive HIV care, such as lack of internet access and low technology literacy. Phone calls can be a simple and effective telehealth option for older rural PLH, as they align with their care preferences, mitigate care barriers, and show promise increasing care engagement. When warranted, complex telehealth options for older rural PLH require tailored approaches, such as portable medical instruments allowing real-time data sharing during home visits or tablet distribution from the clinic. Findings suggest that policy makers and providers support the reimbursement and use of audio-only telehealth services, expand broadband infrastructure and affordability in rural areas, and implement tailored telehealth interventions.
Keywords: Broadband internet; older adults living with HIV; rural; telehealth.
HIV service providers feel audio-only telehealth is effective and feasible for rural older adults living with HIV.Adequate broadband access is essential to implement complex telehealth modalities, such as video visits, for rural older adults living with HIV.The Centers for Medicare and Medicaid Services should continue to reimburse audio-only telehealth services beyond the end of 2024.The United States Federal government should invest further in broadband infrastructure and affordability in rural areas to support telehealth services.