Background

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is the largest single provider of Human Immunodeficiency Virus (HIV) care in the United States. At the end of Fiscal Year (FY) 2025, 31,769 Veterans living with HIV were receiving care in VHA.

VHA has been a national leader in bringing life-saving antiretroviral therapy to underserved rural areas. By using new technologies, VHA continues to expand HIV care and prevention services for rural Veterans. Because of these efforts and effective long-term treatment, Veterans with HIV are living longer. At the end of FY 2025, 24,358 Veterans aged 50 and older were receiving ongoing HIV care in VHA, making VA the largest single provider of geriatric HIV care in the country.

Many rural Veterans live far from large specialty centers, and some have other health problems that make travel and communication difficult. Of the 5,238 rural Veterans living with HIV in FY 2025, many face extra barriers when they try to reach high-quality HIV specialty care and prevention services.

HIV prevention with preexposure prophylaxis (PrEP) can prevent more than 90% of new HIV infections when used correctly. Even so, many Veterans who could benefit from this treatment are not yet receiving it. As of October 2025, 11,293 Veterans were taking PrEP in VHA, but many more remain at risk for HIV infection and need easier access to prevention, including through telehealth.

In addition to building long-term telehealth systems for HIV treatment and PrEP, the VHA Office of Rural Health (ORH) Veterans Rural Health Resource Center–Iowa City created the Telehealth Collaborative Care for Rural Veterans with HIV Infection (HIV-TCC) program. HIV-TCC also works to bring evidence-based technologies for sexually transmitted infection (STI) treatment and prevention to rural areas where infections are still common.

Most recently, the program has worked with national VA offices to expand injectable antiretroviral therapies to rural regions and to deploy DoxyPEP (doxycycline used soon after exposure) to prevent STIs. These efforts are carried out while carefully monitoring and limiting the risk of antibiotic resistance.

Goals and Objectives

The HIV Telehealth Collaborative Care (HIV-TCC) model is designed to strengthen HIV care and prevention for rural Veterans. The program aims to:

• Speed up connection and long-term engagement in care for rural Veterans by using advanced telehealth technologies such as Clinical Video Telehealth (CVT) and VA Video Connect (VVC) to deliver HIV treatment and prevention services over long distances.
• Maintain long-lasting HIV viral suppression for Veterans living with HIV by delivering care through telehealth.
• Reduce the number of new HIV diagnoses by expanding and supporting HIV PrEP programs.
• Create and maintain shared-care relationships between primary care teams in community-based clinics and HIV specialty clinics, so Veterans receive coordinated care.
• Strengthen dynamic, productive working relationships between clinicians and facility telehealth coordinators and technicians.
• Provide mentorship to site leaders, providers from multiple disciplines, and clinic support staff so that telehealth clinical operations can be sustained over the three-year funding period.

In the original pilot, a cluster randomized controlled trial compared telehealth intervention sites with similar sites that did not use HIV-TCC. Before and after the intervention, HIV viral load suppression was measured. Telehealth sites serving rural Veterans showed statistically significant improvements in viral suppression, demonstrating that the model is effective.

Methodology

The HIV Telehealth Collaborative Care model uses several key strategies to build long-term, sustainable HIV care across many different VHA facilities.

• Monthly strategic calls: Participating sites join monthly programmatic Teams calls. These meetings focus on best practices, problem-solving, and planning next steps with the program lead team and, when helpful, within regional groups.
• Data-to-care mentorship: Sites receive guidance on using existing data or creating refined data-to-care models to manage their patient populations. These models support outreach within local service areas and help facilities prepare quarterly reports.
• Expert telehealth seminars: Each month, sites participate in tailored telehealth coaching sessions. These seminars help strengthen local telehealth systems for HIV care at both the facility and regional levels.
• Program office coordination: HIV-TCC leaders communicate regularly with VHA HIV and Infectious Disease program office leaders. Together, they share practical and theoretical best practices for building sustainable telehealth programs that reach rural Veterans.
• Opportunities to share results: Sites have the opportunity to present and publish their intervention work with support and mentorship from ORH, helping spread successful strategies across VA.
• Targeted staffing support: HIV-TCC can provide funding for key telehealth clinical positions at participating sites for up to three years, if program metrics are met and there is clear effort and success in HIV telehealth outreach to rural Veterans. The long-term goal is for facility leadership to take over and make these positions permanent after the program period ends.

Impact on Rural Veteran Health

The HIV-TCC program began as a pilot in 2013 and became a Rural Mentored Implementation project in 2015 at the Veterans Rural Health Resource Center in Iowa City, Iowa. Since then, telehealth use for HIV care has grown steadily, with a sharp increase during the COVID 19 pandemic in 2020–2021. During that time, HIV-TCC helped maintain access to care when in-person clinics were paused and travel and laboratory visits were harder to complete.

• Rural Veterans reported that telehealth was a safe, practical way to continue their ongoing HIV care.
• Since FY 2015, the HIV-TCC program has been successfully implemented at 26 VA Medical Centers (VAMCs). These include the initial site in Iowa City, IA; as well as Houston, TX; Dallas, TX; San Antonio, TX; Indianapolis, IN; Atlanta, GA (serving Dublin, GA); Dayton, OH (with outreach to Columbus, OH and Chillicothe, OH); Tampa, FL; and Jackson, MS. In FY 2020, the program expanded to Phoenix, AZ and Northern Arizona; New Orleans, LA; Portland, OR; Seattle, WA; rural greater Los Angeles, CA; and Togus, ME.
• Further growth included expansion to Memphis, TN in FY 2021; mentorship to St. Louis, MO in FY 2022; and expansion to the VA Pacific Health Care System and Minneapolis, MN VAMC in FY 2023, including outreach to St. Cloud, MN and Black Hills, SD.
• In addition, HIV-TCC has provided informal, unfunded mentorship to sites such as White River Junction, VT and Raleigh/Durham, NC (FY 2019); Birmingham, AL (FY 2020); and Albuquerque, NM (FYs 2020–2021). Ongoing support continues for New Orleans, LA even after local program completion.
• For FY 2023, analysis of 21 VHA facilities directly supported by HIV-TCC found a total of 5,236 HIV telehealth visits (VVC, CVT, or telephone) and 2,161 unique Veterans receiving PrEP for HIV prevention at these facilities.

In October 2025, the program transitioned from an ORH Rural Mentored Implementation project to an ORH Enterprise-Wide Initiative. This shift brought additional evaluation expertise and focused efforts on refining protocols that can be easily replicated and spread nationally across VHA.

Key Takeaways

The ORH HIV Telehealth Collaborative Care model continues to bring up-to-date, high-quality HIV specialty care and prevention to rural Veterans.

• Results from a cluster randomized controlled trial showed significant improvements in HIV viral load suppression for Veterans participating in HIV-TCC telehealth services. This indicates better adherence to antiretroviral therapy and improved health outcomes for rural Veterans.
• The HIV-TCC program helps build strong infrastructure within participating VA facilities. It links HIV specialty clinics to primary care Patient Aligned Care Teams (PACT) and adds enhanced case management for rural Veterans, leading to more coordinated and comprehensive care.
• The HIV-TCC model has been especially important during the COVID 19 pandemic, helping to maintain and expand services for Veterans living with HIV. By creating a strong, collaborative network of specialty and primary care providers who communicate regularly, the program supports better care and outcomes for rural Veterans living with HIV.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• VHA Support Service Center (VSSC), Corporate Data Warehouse (CDW) HIV Cube, accessed February 13, 2023.
• Ohl M. E., Dillon D., Moeckli J., Ono S., Waterbury N., Sissel J., Yin J., Neil B., Wakefield B., Kaboli P. Mixed-methods evaluation of a telehealth collaborative care program for persons with HIV infection in a rural setting. Journal of General Internal Medicine. 2013;28(9):1165–1173.
• Ohl M. E., Richardson K., Kaboli P. J., Perencevich E., Vaughan-Sarrazin M. Geographic access and use of infectious diseases specialty and general primary care services by Veterans with HIV infection: Implications for telehealth and shared care programs. Journal of Rural Health. 2014;30(4):412–421.
• Ohl M. E., Richardson K., Rodriguez-Barradas M. C., Bedimo R., Marconi V., Morano J. P., Jones M. P., Vaughan-Sarrazin M. Impact of availability of telehealth programs on documented HIV viral suppression: A cluster-randomized program evaluation in Veterans Health Administration. Open Forum Infectious Diseases. 2019;6(6).
• Morano J. P., Ohl M. E. VA Telehealth Best Practices. ID Week Conference (Infectious Disease Society of America), October 2019, Washington, DC.

Contact

• Program Contact: Jamie P. Morano, MD, Project Lead, Veterans Rural Health Resource Center–Iowa City, Iowa City VA Health Care System, Iowa City, IA; Tampa VA Medical Center, Tampa, FL. Jamie.Morano@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PROJFY-009541.
• Suggested Citation: Morano, J. (2025). Telehealth Collaborative Care for Rural Veterans with HIV Infection (HIV-TCC). Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp