TY - JOUR
T1 - HIV-related medical service use by rural/urban residents
T2 - A multistate perspective
AU - Wilson, Lucy E.
AU - Korthuis, Todd
AU - Fleishman, John A.
AU - Conviser, Richard
AU - Lawrence, Perrin B.
AU - Moore, Richard D.
AU - Gebo, Kelly A.
N1 - Funding Information:
Supported by the Agency for Healthcare Research and Quality (290-01-0012), the National Institutes of Aging (R01 AG026250), and the National Institutes on Drug Abuse, NIH (K23-DA00523, K24-DA00432, and K23-DA019809). Dr Gebo also received support from the Johns Hopkins University Richard S. Ross Clinician Scientist Award.
PY - 2011/8
Y1 - 2011/8
N2 - Objective: Geographic location may be related to the receipt of quality HIV health care services. Clinical outcomes and health care utilization were evaluated in rural, urban, and peri-urban patients seen at high-volume US urban-based HIV care sites. Methods: Zip codes for 8773 HIV patients followed in 2005 at seven HIV Research Network sites were categorized as rural (population < 10,000), peri-urban (10,000-100,000), and urban ( > 100,000). Clinical and demographic characteristics, inpatient and outpatient (OP) utilization, AIDS-defining illness rates, receipt of highly active antiretroviral therapy (HAART), opportunistic infection (OI) prophylaxis usage, and virologic suppression were compared among patients, using χ2 tests for categorical variables, t-tests for means, and logistic regression for HAART utilization. Results: HIV-infected rural (n=170) and peri-urban (n=215) patients were less likely to be Black or Hispanic than urban HIV patients. Peri-urban subjects were more likely to report MSM as their HIV risk factor than rural or urban subjects. Age, gender, CD4 or HIV-RNA distribution, virologic suppression, HAART usage, or OI prophylaxis did not differ by geographic location. In multivariate analysis, rural and peri-urban patients were less likely to have four or more annual outpatient visits than urban patients. Rural patients were less likely to receive HAART if they were Black. Overall, geographic location (as defined by home zip code) did not affect receipt of HAART or OI prophylaxis. Conclusion: Although demographic and health care utilization differences were seen among rural, peri-urban, and urban HIV patients, most HIV outcomes and medication use were comparable across geographic areas. As with HIV care for urban-dwelling patients, areas for improvement for non-urban HIV patients include access to HAART among minorities and injection drug users.
AB - Objective: Geographic location may be related to the receipt of quality HIV health care services. Clinical outcomes and health care utilization were evaluated in rural, urban, and peri-urban patients seen at high-volume US urban-based HIV care sites. Methods: Zip codes for 8773 HIV patients followed in 2005 at seven HIV Research Network sites were categorized as rural (population < 10,000), peri-urban (10,000-100,000), and urban ( > 100,000). Clinical and demographic characteristics, inpatient and outpatient (OP) utilization, AIDS-defining illness rates, receipt of highly active antiretroviral therapy (HAART), opportunistic infection (OI) prophylaxis usage, and virologic suppression were compared among patients, using χ2 tests for categorical variables, t-tests for means, and logistic regression for HAART utilization. Results: HIV-infected rural (n=170) and peri-urban (n=215) patients were less likely to be Black or Hispanic than urban HIV patients. Peri-urban subjects were more likely to report MSM as their HIV risk factor than rural or urban subjects. Age, gender, CD4 or HIV-RNA distribution, virologic suppression, HAART usage, or OI prophylaxis did not differ by geographic location. In multivariate analysis, rural and peri-urban patients were less likely to have four or more annual outpatient visits than urban patients. Rural patients were less likely to receive HAART if they were Black. Overall, geographic location (as defined by home zip code) did not affect receipt of HAART or OI prophylaxis. Conclusion: Although demographic and health care utilization differences were seen among rural, peri-urban, and urban HIV patients, most HIV outcomes and medication use were comparable across geographic areas. As with HIV care for urban-dwelling patients, areas for improvement for non-urban HIV patients include access to HAART among minorities and injection drug users.
KW - HIV Research Network
KW - HIV/AIDS care
KW - highly active antiretroviral therapy (HAART)
KW - outcomes
KW - quality of care
KW - rural
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U2 - 10.1080/09540121.2010.543878
DO - 10.1080/09540121.2010.543878
M3 - Review article
C2 - 21400307
AN - SCOPUS:79960642618
SN - 0954-0121
VL - 23
SP - 971
EP - 979
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
IS - 8
ER -