Where to Seek Care: An Examination of People in Rural Areas With HIV/ AIDS

Abstract

Though HIV/AIDS has spread to rural areas, little empirical evidence is available on where patients living in these areas receive care. This article presents estimates of rural residents in care for HIV/AIDS, their demographic and health-related characteristics, information about whether they receive care in a rural or urban setting, and data on the drug therapies prescribed. The estimates come from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults receiving care in the contiguous United States. Regardless of the definition used--enrollment site, usual source of HIV care, or site of most recent hospitalization--almost three quarters of rural residents with HIV/AIDS obtained their health care in urban areas. The authors find that differences in the demographic characteristics of those using urban vs. rural care do not drive the decision on where to obtain care, with the primary difference being that people with a rural provider tend to be older. Rural residents with an urban usual source of HIV care incurred significant inconvenience in obtaining care--the majority said their care was not conveniently located, they had substantially longer mean travel times, and over 25% had put off obtaining care in the past 6 months because they did not have a way to get to their provider. Given the considerable burden this places on a chronically ill population,further research is needed to explore how provider supply and provider experience affect the decision to travel for care and how quality of care is affected.

Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

“…KEY RESULTS: Thirty of 32 eligible patients chose TCC over traveling to the HIV clinic for all care. Among 24 patients in TCC during the June 2011-May 2012 evaluation period, median age was 54 (range, 40-79), most (96 %) were men, and median CD4 count was 707 cells/cm 3 (range, 233-1307). VA performance measures were met for > 90 % of TCC patients.…”

“…However, this model does not adapt to rural and low HIV prevalence settings, where there are few healthcare providers with expertise in HIV medicine, and distances between patients and HIV specialty clinics are often great. 3 Historically, the majority of ruraldwelling persons with HIV in the US have traveled long distances to HIV specialty clinics in urban areas, often foregoing care due to travel burdens. 3 This was the case in the Iowa City Veterans Affairs (ICVA) healthcare system.…”

“…3 Historically, the majority of ruraldwelling persons with HIV in the US have traveled long distances to HIV specialty clinics in urban areas, often foregoing care due to travel burdens. 3 This was the case in the Iowa City Veterans Affairs (ICVA) healthcare system. In 2009, ICVA cared for approximately thirty veterans with HIV infection who Electronic supplementary material The online version of this article (doi:10.1007/s11606-013-2385-5) contains supplementary material, which is available to authorized users.…”

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

“…The number of hospitals and physicians per square mile were considered because studies indicate that transportation tends to be a barrier to obtaining health care among people living with HIV infection. 23,24 The distance between the health care provider and any given person's residence was not available, so the density of providers and hospitals was used as a proxy for travel distance as a barrier. The county-specific average number of HIV tests at publically funded counseling and testing sites during 2007-2011 was obtained from the Florida DOH, 25 as was the location of publically funded sites (Florida DOH, personal communication, August 15, 2013).…”

Comparison of health service utilization between Aboriginal and non-Aboriginal people living in the Bella Coola Valley.

“…It is an unreasonable expectation that all general practitioners will be 'experts' in all illnesses and conditions (Overland, Yue & Mira, 2001;Schur et al, 2002 et al, (2002) they are also more likely to move into a more urban setting once the condition or illness worsens or if it is considered 'stigma' provoking. Rural residents tend to utilize health services less frequently than their urban counterparts and for the most part, tend to use less costly services (Overland, Yue, Mira, 2001;Saag, Doebbeling, et al, 1998;Thiede-Call, Casey, and Radcliff, 2000).…”