Lessons Learned from COVID: Continuud Uses Technology to Eliminate Barriers to HIV Care and Treatment During the Pandemic

A key message from FCAA’s recent Converging Epidemics report is that the challenges and stresses highlighted by COVID-19 are not new for people living with or at risk of HIV; they reflect the structural, systemic issues that have disproportionately affected this community for decades.  The report shares bright spots of community-led innovation, as well as recommendations for funders and governments on how to address the intersections of COVID-19, HIV, and inequality. In follow up FCAA will continue to share stories that highlight additional bright spots that also reinforce the report’s key recommendations. The following blog spotlights the work of Continuud – a grantee partner of FCAA member, the Health Foundation of Greater Indianapolis (the Health Foundation) – and reinforces the role that technology equity can play in responding to COVID-19 and HIV.

Founded by serodiscordant couple, Nate and Richard Walsh, Continuud is a health technology company working to uplift those in need – particularly those living with HIV – with innovative technological solutions. The company’s newest platform, the Patient Tablet Access Program (Continuud Access), was designed to eliminate the socioeconomical barriers to accessing telehealth.

1. How did you start working with The Health Foundation?

We have been working with them for almost three years as part of a statewide initiative to use digital advertising to drive HIV testing and reconnecting with those lost to care. That project evolved over the years to include digital infrastructure, such as online scheduling, automated communications, digital forms, and interactive tablets used during client appointments. Our relationship with The Health Foundation gave us the opportunity to get to know AIDS Service Organizations (ASOs) throughout Indiana intimately and to really understand their unique needs and the challenges facing their clients. The Health Foundation has been one of our biggest advocates because they understand the role that rapid innovation and technology play in ending the HIV epidemic. They have really given us the space and autonomy to be innovative and work on new solutions.

2. Tell us about Continuud’s work.

We’re big advocates for the idea that healthcare must become deeply personalized and proactive if people living with HIV and other chronic illnesses are going to advocate for themselves and truly understand how to manage their illness. We wanted to bring two concepts — mobile health intervention and deeply personalized care — into an accessible, innovative platform.

Continuud Access is a great example. We knew that by equipping under-resourced clients — particularly in rural areas — with a data-connected, video-ready device, we could address barriers to care including transportation, lack of social support, local provider compassion, and access to mental health services. Continuud Access provides 8-inch tablets with a 4G data connection to clients. Each device is customized by the health care provider to include personalized tools that clients need for care. The interface, apps, language, and accessibility are unique to the client using it, and evolves along with their treatment needs and plans.

“The Health Foundation of Greater Indianapolis is proud to partner with Continuud to help ensure people living with HIV are able to access the services they need to remain connected to care and virally suppressed. The COVID-19 pandemic exacerbated the barriers for clients across Indiana and their access to healthcare services, case management, transportation, and the digital divide. As a result of the remarkable tablet engagement platform, clients were not only able to maintain their health during the pandemic by virtually visiting with providers and accessing social services, most were able to thrive and improve their health outcomes. Continuud is one of the best examples of a community focused company taking a crisis and partnering with the public health sector to facilitate an opportunity for better collaboration and improved outcomes for individuals living with HIV.”

Jason E. Grisell, President & CEO, The Health Foundation of Greater Indianapolis, Inc.

3. How did COVID-19 affect Continuud?

Our clients started closing their doors and moving fully remote. They had to stop services and testing to keep their staff and clients safe. We knew that the most affected clients were at serious risk of fully disengaging from care, particularly those who never reached viral suppression, frequently missed appointments, were housing and/or food insecure, and the elderly.

Early on, a lot of people started to adopt telehealth. On the surface, it looks like a clean solution to a growing problem. But when you pull back the curtain you realize it also introduces a new set of barriers to care to the equation:

• No access to smart devices
• Unreliable/lack of data connection for quality care
• No understanding of how to use the devices or access the services
• Lack of trust in technology being used for health services

We have always been emotionally connected to our work, but COVID-19 really lit a fire under our team. We recognized the risk to community health organizations very early, and we knew that we had the knowledge and raw materials to help stabilize and reinforce our clients against the full impact of COVID-19. We worked round the clock to help our clients get the hardware they needed to work remotely, the software they needed to be productive and interact with clients, and the knowledge they needed to step into digital care with a base level of confidence. We launched in May 2020 and now have almost 500 devices deployed across Indiana, Kentucky, New Jersey, and Texas. We are on version 2.0 of our platform, with new major features releasing every month.

One of the most important aspects of our platform is that it’s software agnostic. Providers don’t need to buy a new telehealth system or build new workflows. We provide the technology to address the barriers, and our clients continue to use the telehealth platforms they already know and love. We are providing the technology necessary for even the most challenged clients to be able to access and participate in telehealth in a meaningful way that keeps them engaged in care by clearing traditional barriers out of the way.

4. Do you think COVID-19 has impacted the way we think about and use telehealth?

It’s really important to broaden the understanding of what telehealth is or can be. Most people think of telehealth as a video call between provider and patient, but it can and should be so much more. It should be holistic including access to monitoring, frequent client touchpoints, and peer support and mentoring. It should also reduce the burden on care teams and support educational experiences to empower clients.

And that’s just within the existing healthcare model. Imagine what’s to come as a result of the telehealth renaissance formed under COVID-19. It really opens the doors to new opportunities. Telehealth and digital interventions can facilitate so many aspects of the continuum of care. We are confident that providers that are really leaning into telehealth are going to find that it not only improves clinical outcomes but transforms the culture of healthcare for both provider and patient.

5. What kind of outcomes are you seeing now? Has that changed during the pandemic?

For many clients, this is their first smart device. People are consuming educational material rapidly. They are taking advantage of social support programming consistently. They are learning about how to manage their illness, applying for jobs, taking life skills classes, meditating, texting their mental health provider, and attending digital support groups, including virtual AA meetings. Providers have reported that no-show rates are down significantly; some have seen as much as a 30-point drop to 5% or less. A client of one organization told them that their tablet is the only reason they have been able to stay sober during the pandemic. Being able to text their care coordinator, Zoom with their counselor, and attend online AA meetings made all the difference in their ability to maintain their sobriety.

6. How have communities you work with been impacted by COVID-19? How are you/your clients balancing that with the impact of COVID-19 with the ongoing impact of living with HIV?

I think all communities are experiencing a similar set of changes: unemployment is rising, people are facing mental health challenges, and substance use is increasing, just to name a few. COVID-19 is creating a storm of new detriments to health, some that may not even fully materialize for months or years.

The reality is that COVID-19 is affecting everyone, whether you’re a provider or patient. All our systems and infrastructure need to evolve and conform to our new reality. There is no “going back to normal” after COVID-19. We might eradicate the virus, but like any other threat to our existence, we are always going to live with the crater it created in our lives. The COVID-19 pandemic is forcing healthcare to evolve at a rapid pace, and that pressure is producing an influx of new, innovative solutions. We like to think that our tablets are one of those solutions.

7. What message would you give HIV-informed funders, based on your experiences during COVID-19? What do you want them to know? 

COVID-19 has forced providers to react quickly, often implementing whatever toolkit was within reach in order to respond to a constantly evolving trauma. It’s important to recognize that for many organizations, the infrastructure that was erected in response to COVID-19 was never meant to be permanent, and it can’t support the long-term weight of ongoing digital care. This new landscape is here to stay, and we need to implement real, lasting infrastructure around a digital-first model. That means closely examining the barriers and redefining what it means to address patient needs. A concept that was an airtight truth in 2019 may not hold water now. We need to give providers and patients the time, tools, and support to grow into this new model of care. If we embrace the opportunity and potential that COVID-19 has made available to this medical community, together we can make great strides in developing innovative solutions to end the HIV epidemic.