Research Activities, February 2012: Chronic Disease: HIV outcomes and medication use are similar between rural and urban HIV patients

Research Activities, February 2012: Chronic Disease: HIV outcomes and medication use are similar between rural and urban HIV patients

HIV outcomes and medication use are similar between rural and urban HIV patients

Whenever possible, patients with HIV infection want to receive care locally where they live. While patients living in urban areas can access a variety of treatment sites, rural patients and those in outlying urban areas (peri-urban) may not have as many services available to them. As a result, they may decide to seek care at major treatment sites located in urban areas.

John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), and colleagues found that overall, most HIV outcomes and medication use were comparable across patients living in rural, urban, and peri-urban areas. The study involved 8,773 patients with HIV infection who were followed clinically at 7 high-volume, urban HIV Research Network sites in 2005. Each patient was determined to be rural if they lived in an area with a population of less than 10,000 or urban if the population was greater than 100,000.

Patients considered to be "peri-urban" lived in areas with populations between rural and urban parameters. Rural and peri-urban patients were significantly less likely to be black (22 percent and 21 percent, respectively) compared with urban patients (40 percent). Those living in peri-urban areas were more likely to have an HIV transmission risk factor of men who have sex with men. The researchers did not find any significant differences in median CD4 cell counts, CD4 distribution, and median HIV viral loads (all indicators of HIV disease progression) among the three groups. Overall, rural and peri-urban individuals receiving care at urban sites had high levels of appropriate medication to prevent opportunistic infections (infections that are more prevalent among patients with deficient immune systems) and good HIV outcomes compared with their urban-living counterparts. However, the researchers discovered some health care use differences.

For example, patients living in rural and peri-urban areas were less likely to have four or more outpatient visits a year than their urban counterparts. The findings suggest that HIV patients living in non-urban areas can receive high-quality HIV care if they take advantage of high-volume, urban-based care sites. The study was supported in part by AHRQ (Contract No. 290-01-0012).

More details are in "HIV-related medical service use by rural/urban residents: A multistate perspective," by Lucy E. Wilson, M.D., Todd Korthuis, M.D., M.P.H., Dr. Fleishman, and others in the August 2011 AIDS Care 23(8), pp. 971-979. Reprints (AHRQ Publication No. 12-R006) are available from the AHRQ Publications Clearinghouse.