title: HIV-related medical service use by rural/urban residents: a multistate perspective.
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 χ(2) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Maryland Department of Health and Mental Hygiene, Infectious Disease and Environmental Health Administration, Baltimore, MD, USA. lewilson@dhmh.state.md.us
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Wilson
authors.forename: Todd
authors.initials: T
authors.lastname: Korthuis
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Richard
authors.initials: R
authors.lastname: Conviser
authors.forename: Perrin B
authors.initials: PB
authors.lastname: Lawrence
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D019037:Urban Health Services / Q000706:statistics & numerical data*; D055815:Young Adult