Trust, Telehealth Use, and Healthcare Transition Among Adolescents and Young Adults With HIV During Early COVID-19: A Cross-Sectional Study (Preprint)

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Abstract
BACKGROUND Adolescents and young adults with HIV (AYAWH) experience poor retention in care; suboptimal viral suppression; and frequent disengagement during healthcare transition compared to older adults. The COVID-19 pandemic rapidly expanded telehealth use, offering both opportunities and challenges for engagement. Trust in providers is a critical determinant of adherence and outcomes, yet little is known about how relational trust interacts with trust in telehealth and transition experiences. OBJECTIVE This study examined predictors of patient-provider trust and trust in telehealth; assessed whether trust predicted engagement outcomes; and explored the roles of stigma, age, and transition status among AYAWH. METHODS We conducted a cross-sectional observational study of 109 AYAWH (ages 18–30) receiving care at two Colorado HIV programs. Participants completed validated measures of patient-provider trust, perceived provider caring, trust in telehealth, HIV stigma, and mental health, in conjunction with self-reported adherence over a 2-month period (December 2020 through January 2021). Clinical data were abstracted for visits, HIV RNA PCR results, and telehealth encounters during the 16 months spanning pre-COVID (July 2019 - March 2020) and post-COVID onset (March -November 2020). Descriptive, bivariate, and multivariable regression analyses tested associations between trust, stigma, transition status, telehealth use, and engagement outcomes. RESULTS Participants were 60% (n=65) male and 39.4% (n=43) living with perinatally acquired HIV. Patient-provider trust and perceived provider caring were high (mean Health Care Relationship Trust = 44.3/52; mean Watson Patient Caring Score = 6.4/7) and both predicted trust in telehealth (β =.76 and β =.37, respectively, P<.001). Stigma was negatively associated with perceived caring (β =–.27, P=.005). Seventy-one percent of youth had ≥1 telehealth visit. Telehealth use was associated with greater likelihood of viral suppression (OR=2.30, 95% CI 1.05–5.02, P=.037) and a higher number of HIV-related visits (β =.24, P=.042). Older age and longer provider relationships predicted telehealth and hybrid use. Post-transition youth had fewer telehealth visits (β=–.23, P=.037) but were more likely to achieve viral suppression (P=.009). CONCLUSIONS Trust in providers strongly predicted trust in telehealth, supporting the extension of relational trust into digital domains. Telehealth use was associated with improved engagement and viral suppression pre-transition. Post-transition youth used telehealth less frequently despite stronger virologic outcomes. Findings suggest introducing telehealth earlier in pediatric care may scaffold continuity of care, easing transition into adult services. Nurse-led, youth-centered telehealth models that integrate trust-building, stigma screening, and mental health support enhance engagement and outcomes for AYAWH.

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