Objective
Geographic location may be related to the receipt of quality HIV healthcare services. Clinical outcomes and healthcare utilization were evaluated in rural, urban and peri-urban patients seen at high-volume U.S. urban-based HIV care sites.
Methods
Zip codes for 8,773 HIV patients followed in 2005 at 7 HIV Research Network sites were categorized as rural (population<10K), peri-urban (10K – 100K) and urban (>100K). 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 ≥4 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 healthcare 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 IDUs.