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

Ohl, Michael; Richardson, Kelly; Kaboli, Peter J.; Perencevich, Eli N.; Vaughan-Sarrazin, Mary

doi:10.1111/jrh.12070

Cited by 33 publications

(31 citation statements)

References 16 publications

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“…However, these differences are more likely because the current work captures drive times to HIV care for many urban communities, including those that are in less densely populated metropolitan areas, instead of for single super‐urban cities that may not generalize to all urban locales in the US. This work corroborates notable urban–rural disparities in geographic accessibility to HIV care: rural veterans living with HIV may need to travel much longer to reach primary or specialty HIV care compared to urban veterans living with HIV . Such urban–rural differences in geographic accessibility to HIV care may influence care engagement among PLHIV in urban versus rural US communities .…”

Section: Discussionsupporting

confidence: 66%

“…However, the large percentage of PLHIV who have lower incomes and may rely on federally funded programmes to support care delivery suggests that the sample used in the current analysis adequately captures sites providing comprehensive, coordinated HIV care in the US. Further, although our analysis does not include sites primarily serving veterans, our results complement existing literature suggesting that rural veterans living with HIV generally have longer drive times to primary and infectious disease specialty care delivered by the Department of Veterans Affairs . Third, while we selected a 30‐min threshold for comparability to existing primary care thresholds, we acknowledge that there is no universally accepted threshold for suboptimal geographic accessibility in the US, and that geographic accessibility thresholds appropriate for the US may not apply in other settings with different resources, health care systems and geographies.…”

Section: Discussionmentioning

confidence: 66%

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Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban–rural differences

et al. 2019

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Achieving US state and municipal benchmarks to end the HIV epidemic and promote health equity requires access to comprehensive HIV care. However, this care may not be geographically accessible for all people living with HIV (PLHIV). We estimated county‐level drive time and suboptimal geographic accessibility to HIV care across the contiguous US, assessing regional and urban–rural differences. We integrated publicly available data from four federal databases to identify and geocode sites providing comprehensive HIV care in 2015, defined as the co‐located provision of core HIV medical care and support services. Leveraging street network, US Census and HIV surveillance data (2014), we used geographic analysis to estimate the fastest one‐way drive time between the population‐weighted county centroid and the nearest site providing HIV care for counties reporting at least five diagnosed HIV cases. We summarized HIV care sites, county‐level drive time, population‐weighted drive time and suboptimal geographic accessibility to HIV care, by US region and county rurality (2013). Geographic accessibility to HIV care was suboptimal if drive time was >30 min, a common threshold for primary care accessibility in the general US population. Tests of statistical significance were not performed, since the analysis is population‐based. We identified 671 HIV care sites across the US, with 95% in urban counties. Nationwide, the median county‐level drive time to HIV care is 69 min (interquartile range (IQR) 66 min). The median county‐level drive time to HIV care for rural counties (90 min, IQR 61) is over twice that of urban counties (40 min, IQR 48), with the greatest urban–rural differences in the West. Nationally, population‐weighted drive time, an approximation of individual‐level drive time, is over five times longer in rural counties than in urban counties. Geographic access to HIV care is suboptimal for over 170,000 people diagnosed with HIV (19%), with over half of these individuals from the South and disproportionately the rural South. Nationally, approximately 80,000 (9%) drive over an hour to receive HIV care. Suboptimal geographic accessibility to HIV care is an important structural barrier in the US, particularly for rural residents living with HIV in the South and West. Targeted policies and interventions to address this challenge should become a priority.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban–rural differences

et al. 2019

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“…Patients who are not retained in care report more transportation-related challenges such as transportation costs, unreliable public transportation, and travel distance, as compared with PLWH who are retained in care 34. One study among US Veterans with HIV showed that longer travel time to HIV specialty clinics was associated with decreased use of these clinics 14. PLWH who are out of care face difficulties with scheduling appointments and struggle to consistently attend regular clinic visits.…”

Section: Clinical Usementioning

confidence: 99%

Integration of Telehealth Services in the Healthcare System: With Emphasis on the Experience of Patients Living with HIV

Dandachi

Lee

Morgan

et al. 2019

Journal of Investigative Medicine

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The US Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration. Many studies have supported the use of telehealth to increase convenience to patients, improve patient satisfaction, diminish healthcare disparities, and reduce cost that will ultimately lead to improvement in clinical outcomes and quality of care. However, guaranteeing confidentiality, educating patients and providers, and obtaining insurance reimbursement are some of the challenges that face the implementation of telehealth program. The use of telehealth has been investigated in acute infections, such as endocarditis and chronic infections as in hepatitis C, and HIV. The purpose of this review is to focus on the use of telehealth services for people living with HIV (PLWH). For PLWH, telehealth could be particularly useful by connecting specialty providers to an underserved population and addressing many of the factors identified as barriers to HIV care. To date, the literature supports the use of telehealth for the management of chronic diseases including HIV. Most of the studies showed a high acceptability and positive experience with telehealth services among PLWH. However, fewer studies have evaluated telemedicine for chronic direct care of PLWH. Well-designed studies are needed to show that the implementation of telehealth could improve the HIV care continuum. In addition, future research should focus on identifying the group of patients that could benefit the most from such intervention.

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“…97 , 99 Studies evaluating the effect of telehealth models have found similar or even improved HIV and quality-of-life–related outcomes between individuals receiving telehealth HIV care and conventional HIV care. 100–102 …”

Section: Future Directions For Research and Demonstration Projectsmentioning

confidence: 99%

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

Schafer

Albrecht

Dillingham

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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107

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The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural–urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.

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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

Cited by 33 publications

References 16 publications

Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban–rural differences

Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban–rural differences

Integration of Telehealth Services in the Healthcare System: With Emphasis on the Experience of Patients Living with HIV

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

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