The Vermont model for rural HIV care delivery: eleven years of outcome data comparing urban and rural clinics.
BACKGROUND
Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers.


OBJECTIVE
To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic.


METHODS
This was a retrospective cohort study.


RESULTS
Over an 11-year period 363 new patients received care, including 223 in the urban clinic and 140 in the rural clinics. Patients in the 2 cohorts were demographically similar and had similar initial CD4 counts and viral loads. There was no difference between the urban and rural clinic patients receiving Pneumocystis carinii prophylaxis (83.5% vs 86%, P= .38) or antiretroviral therapy (96.8% vs 97.5%, P= .79). Both rural and urban cohorts had similar decreases in median viral load from 1996 to 2006 (3,876 copies/mL to <50 copies/mL vs 8,331 copies/mL to <50 copies/mL) and change in percent of patients suppressed to <400 copies/mL (21.4%-69.3% vs 16%-71.4%, P= .11). Rural and urban cohorts had similar increases in median CD4 counts (275/mm(3)-350/mm(3) vs 182 cells/mm(3)-379/mm(3)). A repeated measures regression analysis showed that neither fall in viral load (P= .91) nor rise in CD4 count (P= .64) were associated with urban versus rural site of care. Survival times, using a Cox proportional hazards model, were similar for urban and rural patients (hazard ratio for urban = 0.80 [95% CI, 0.39-1.61; P= .53]).


CONCLUSIONS
This urban outreach model provides similar quality of care to persons receiving care in rural areas of Vermont as compared to those receiving care in the urban center.
Grace
Christopher
C
Infectious Diseases Unit, Fletcher Allen Health Care, Burlington, Vermont 05401, USA. Christopher.grace@vtmednet.org
Kutzko
Deborah
D
Alston
W Kemper
WK
Ramundo
Mary
M
Polish
Louis
L
Osler
Turner
T
D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards; D019037:Urban Health Services / Q000592:standards; D014707:Vermont / Q000453:epidemiology