HIV Telehealth Collaborative Care
- Need: To increase access to specialty care for rural veterans living with HIV.
- Intervention: The HIV Telehealth Collaborative Care (TCC) study connects these patients with HIV specialists via clinical video telehealth or VA video connect and works to create shared care relationships with primary care teams in rural areas.
- Results: The HIV TCC program provides HIV specialty care access to rural veterans in a sustainable manner with infrastructure, mentorship, and capacity building.
Rural veterans with HIV have more challenges than their
urban counterparts to access specialty medical care due
to transportation and wireless connectivity issues.
Often, rural veterans are less likely to receive the most
recent advances in HIV treatment and recommended
maintenance vaccinations and are often in greater need of
related social support services.
The HIV Telehealth Collaborative Care (TCC) study works
to improve care for these patients by connecting veterans
via telehealth services in rural areas to HIV specialists
in urban VA hospitals. The HIV TCC program began in
Georgia and Texas and has since expanded to include
Arizona, Florida, Indiana, Louisiana, Maine, Mississippi,
Ohio, Oregon, and Washington, with new outreach to
Missouri and New Mexico planned for 2022.
Researchers received funding from VA's Office of Rural
Health to develop, evaluate, and implement a program that
would improve access to specialty care for rural veterans
with HIV, with ongoing quality improvement work in active
and sustaining sites for telehealth program
Patients attend their videoconferencing sessions at the
nearest VA community-based outpatient clinic (CBOC) and
receive care from distant HIV specialty care teams.
Patients can also complete VA video connect visits in
their own homes or a secure office space. Services
include maintaining HIV care and ensuring associated care
metrics as coordinated with the primary care provider.
Along with the patients and specialists, video conference
sessions can include:
- Advanced nurse care managers
- Primary care physicians (PCPs)
- Telehealth specialists
In addition, local primary care teams in rural areas work
with HIV specialists at the centrally located hub to
provide "shared care" for rural veterans with HIV. The
rural primary care teams focus on reducing cardiovascular
risk by treating high blood pressure, diabetes,
hyperlipidemia, and tobacco smoking; checking bone
density and renal function; and ensuring immunizations
are up to date.
Researchers offered the telehealth option to veterans who
live closer to a CBOC or primary care clinic than to a VA
hospital with HIV specialty care and who have to drive at
least 90 minutes to one of these clinics. Most veterans
(90% in the pilot studies) chose the telehealth option
and were satisfied or very satisfied with their care.
Rates of HIV viral control remained high (over 90%) and
smoking cessation care processes improved. Results for
impacts on care outcomes in replication studies show
improvement in retention in care in telehealth
The HIV TCC program builds solid infrastructure
foundations within participating VAs to integrate HIV
specialty care to corresponding primary care Patient
Aligned Care Teams with enhanced case management for
The program has been replicated in VA sites across the
country in 2019, with additional evaluations ongoing.
With the COVID-19 pandemic, there has been successful
uptake of VA Video Connect visits, which has accelerated
the uptake of telehealth technologies for HIV care in
addition to enhancing the collaborative model between
primary care and HIV specialists.
For more information about HIV TCC:
Ohl, M.E., Richardson, K., Rodriguez-Barradas, M.C.,
Bedimo, R., Marconi, V., Morano, J.P., … &
Vaughan-Sarrazin, M. (2019). Impact
of Availability of Telehealth Programs on Documented HIV
Viral Suppression: A Cluster-Randomized Program
Evaluation in the Veterans Health Administration.
Open Forum Infectious Diseases, 6(6).
Rural primary care teams have multiple competing demands
for their limited time. This barrier can be overcome by
providing additional support to rural primary care teams
with HIV care managers at the telehealth hub site who can
work directly with veterans by telephone. This program is
also utilizing VA video connect and video on demand
services to expand reach to rural veterans due to high
Other barriers to care in rural areas are limited
internet or cellular capabilities, despite the
availability of specialists on these modalities. This
program works with each participating site to work
through options for connected care utilizing
This program can be replicated in rural areas served by
clinics with potential telehealth connections to HIV
specialty clinics. Shared care relationships between
distant HIV specialists and local primary care teams can
start with a narrow focus on engaging primary care teams
in cardiovascular risk factor management and can expand
Some rural patients with HIV may prefer to attend
telehealth visits in a clinic that is near enough to be
accessible but far enough from home to avoid concerns
about loss of privacy.
For other details on replication or interest in
participating in this program from your affiliated VA,
please contact the program lead listed below.
Jamie P. Morano, MD, Project Lead
HIV Telehealth Collaborative Care Program
HIV and AIDS
July 21, 2017
Date updated or reviewed
September 10, 2021
Suggested citation: Rural Health Information Hub,
HIV Telehealth Collaborative Care [online]. Rural Health Information Hub. Available at:
[Accessed 11 August 2022]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.