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

## TL;DR

During the pandemic, NYC TB clinics used telehealth to provide care, finding it effective and accessible for many patients.

## Contribution

The study evaluates the effectiveness and reach of telehealth services for TB care during the pandemic in a diverse patient population.

## Key findings

- Telehealth visit completion became comparable to in-person visits over time for TB and LTBI patients.
- Among drug-susceptible TB patients, telehealth users had higher treatment completion rates within one year.
- Telehealth services reached diverse demographics without significant disparities in age or language for TB patients.

## 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.

During the COVID-19 pandemic, New York City Health Department tuberculosis (TB) clinics suspended non-essential in-person services, closed three of four clinics and rapidly shifted many services to telehealth. We wanted to understand the reach and effectiveness of this telehealth program. We compared patients with TB and latent TB infection who used telehealth with those who received only in-person care between April 2020 and December 2022. We found that patients with TB who used telehealth were similar in age and primary language to those seen in person. Visit completion was lower for telehealth early in the pandemic but became comparable to in-person visits over time. Among patients with drug-susceptible TB, a higher proportion of telehealth users completed treatment within one year compared to in-clinic patients. These findings suggest that telehealth was able to maintain continuity of TB care during a public health emergency and, in many cases, served as an acceptable alternative to in-person visits.