HIV-related medical service use by rural/urban residents: A multistate perspective

Lucy E. Wilson, Todd Korthuis, John A. Fleishman, Richard Conviser, Perrin B. Lawrence, Richard D Moore, Kelly Gebo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)971-979
Number of pages9
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Volume23
Issue number8
DOIs
StatePublished - Aug 2011

Fingerprint

medical service
HIV
resident
prophylaxis
Highly Active Antiretroviral Therapy
utilization
suppression
Geographic Locations
Opportunistic Infections
Patient Acceptance of Health Care
health care
rural population
health care services
multivariate analysis
AIDS
medication
Outpatients
illness
logistics
Demography

Keywords

  • highly active antiretroviral therapy (HAART)
  • HIV Research Network
  • HIV/AIDS care
  • outcomes
  • quality of care
  • rural

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Social Psychology

Cite this

HIV-related medical service use by rural/urban residents : A multistate perspective. / Wilson, Lucy E.; Korthuis, Todd; Fleishman, John A.; Conviser, Richard; Lawrence, Perrin B.; Moore, Richard D; Gebo, Kelly.

In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, Vol. 23, No. 8, 08.2011, p. 971-979.

Research output: Contribution to journalArticle

Wilson, Lucy E. ; Korthuis, Todd ; Fleishman, John A. ; Conviser, Richard ; Lawrence, Perrin B. ; Moore, Richard D ; Gebo, Kelly. / HIV-related medical service use by rural/urban residents : A multistate perspective. In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. 2011 ; Vol. 23, No. 8. pp. 971-979.
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abstract = "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.",
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