Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system.
Rural persons with HIV face barriers to care that may influence adoption of advances in therapy. We performed a retrospective cohort study to determine rural-urban variation in adoption of raltegravir-the first HIV integrase inhibitor-in national Veterans Affairs (VA) healthcare. There were 1,222 veterans with clinical indication for raltegravir therapy at time of its FDA approval in October 2007, of whom 223 (19.1%) resided in rural areas. Urban persons were more likely than rural to initiate raltegravir within 180 days (17.3% vs. 11.2%, P = 0.02) and 360 days (27.5% vs. 19.7%, P = 0.02), but this gap narrowed slightly at 720 days (36.3% vs. 31.8%, P = 0.19). In multivariable analysis adjusting for patient characteristics, urban residence predicted raltegravir adoption within 180 days (odds ratio 1.72, 95% CI 1.09-2.70) and 360 days (OR 1.63, 95% CI 1.13-2.34), but not 720 days (OR 1.26, 95% CI 0.84-1.87). Efforts are needed to reduce geographic variation in adoption of advances in HIV therapy.
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA. michael.ohl@va.gov
Michael
M
Ohl
Brian
B
Lund
Pamela S
PS
Belperio
Matthew Bidwell
MB
Goetz
David
D
Rimland
Kelly
K
Richardson
Amy
A
Justice
Eli
E
Perencevich
Mary
M
Vaughan-Sarrazin
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000639:trends*; D004059:Diffusion of Innovation; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D019428:HIV Integrase Inhibitors / Q000627:therapeutic use*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011760:Pyrrolidinones / Q000627:therapeutic use*; D000068898:Raltegravir Potassium; D012111:Residence Characteristics; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population; D014728:Veterans / Q000706:statistics & numerical data; D019562:Viral Load; D055815:Young Adult
D019428:HIV Integrase Inhibitors; D011760:Pyrrolidinones; D000068898:Raltegravir Potassium