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Rural patients living with HIV fare better with expert care
Experienced HIV providers are needed to deliver quality care in rural settings.
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People living with HIV in rural areas can receive high quality care if they are able to copy the health care habits of their urban counterparts, according to recent study.
Studies have shown that patients under the care of experienced HIV providers have better longterm outcomes, Lucy E. Wilson, MD ScM, assistant professor of infectious diseases at Johns Hopkins University in Baltimore, told Infectious Disease News.
In this latest study, Wilson and her colleagues examined clinical outcomes and health care utilization in rural and urban patients when both groups were treated at high volume, urban care sites. Urban patients made better use of health care facilities and had higher rates of PCP prophylaxis than rural patients. Patients with four or more outpatient visits per year were more than three times as likely to use PCP prophylaxis.
“Because of the prevalence of HIV in rural areas, there is a need for experienced HIV providers in rural settings to deliver quality care,” Wilson said. “Innovation is necessary to provide this care to patients with HIV who have more access barriers.”
Identifying barriers, such as stigma and transportation, should be considered an important step in linking rural patients with HIV with expert care and increasing their outpatient visits, Wilson said.
Urban versus rural
Data from urban (n=13,640) and rural (n=333) adults were collected from five sites in the HIV Research Network. The network is comprised of 17 HIV-dedicated sites in the United States. Patients from five sites, four academic and one community-based, were used in this study. Median patient age was 41 years and more than 75% of participants were men.
Compared with rural patients with HIV using the same health care providers, urban patients were more likely to be minorities; urban patients were 38% black and 17% Hispanic and rural patients were 26% black and 9% Hispanic. Urban patients were also more likely to be men who had sex with men (53%) than rural patients (44% MSM). Intravenous drug use risk was the same for both groups at 18% and the risk of heterosexual transmission was 32% in urban patients and 35% in rural patients.
Urban HIV patients used more health care with a mean 2.93 outpatient visits per year vs. 2.29 visits per year by rural patients (P=.002). At 80%, urban patients also had higher rates of PCP prophylaxis if CD4<200 than rural patients at 59% (P=.001). In both groups, having four or more outpatient visits per year was associated with PCP prophylaxis in an 3.93 adjusted odds ratio (95% CI).
HAART usage, virologic suppression and clinical factors were all similar between rural and urban patients, according to the study. – by Kirsten H. Ellis
For more information:
- Wilson LE, Fleishman JA, Korthuis PT, et al. Quality of care outcomes among rural and urban HIV patients in a multisite cohort. Poster presented at: 44th Annual Meeting of the Infectious Disease Society of America; Oct. 12-15, 2006; Toronto.