Is anybody out there? Integrating HIV services in rural regions

Nguyen, Trang; Whetten, Kathryn

doi:10.1016/s0033-3549(04)50211-x

Cited by 9 publications

(2 citation statements)

References 7 publications

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“…The push for decentralization of HIV care to rural areas in the United States in the 1990s was not as successful as hoped, largely due to concerns about the quality of care, confidentiality, and stigma (McKinney, 2002; Nguyen & Whetten, 2003; Reif, Golin, & Smith, 2005; K. Whetten & Pence, 2013; K.…”

Section: Discussionmentioning

confidence: 99%

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

et al. 2014

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Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV Care and Treatment Centers (CTCs) from hospitals to local health centers. Between November 2008 and June 2009, 492 HIV-infected patients in established care at two referral hospitals in Moshi, Tanzania, and 262 persons newly diagnosed with HIV were selected for participation in a prospective cohort study entitled Coping with HIV/AIDS in Tanzania. Clinical records and participant self-reports, collected between June and November 2012, were used to describe retention in care and transitions between CTCs during the study period. After a mean follow-up period of 3.5 years, 10 percent of participants had died, 9 percent were lost to follow-up, and 11 percent had moved. Of the remaining participants enrolled from CTCs, more than 90 percent reported at least one CTC visit during the previous six months, with 98 percent still in care at the CTC at which they were enrolled. Nearly 3 out of 4 newly diagnosed clients listed a referral hospital as their primary CTC. Fewer than 10 percent of participants ever sought care at another CTC in the study area; nearly 90 percent of those in care bypassed their closest CTC. Administrative data from all facilities in the study area indicate that new clients, even after the scale-up from 8 CTCs in 2006 to 21 CTCs in 2008, disproportionately selected established CTCs, and client volume at newly approved facilities was highly variable. Despite the decentralization of HIV care and treatment in this setting, many patients continue to bypass their closest CTC to seek care at established facilities. Patient preferences for HIV care, which may inform optimal resource utilization, are largely unknown and warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

et al. 2014

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“…10 A third potential barrier in some rural areas is fragmented HIV services due to fewer full-time AIDS service organizations than in urban areas. 11 Rural areas may be receiving less Ryan White funding per patient relative to urban areas, 12 and limited social service benefits and support are associated with less adherence to antiretroviral therapy. 13 Furthermore, HIV-related stigma may be more pronounced in rural areas, posing an additional barrier to treatment.…”

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confidence: 99%

Rural AIDS Diagnoses in Florida: Changing Demographics and Factors Associated With Survival

Trepka

Niyonsenga

Maddox

et al. 2013

The Journal of Rural Health

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Purpose To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents. Methods Florida surveillance data for people diagnosed with AIDS during 1993–2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTA). Rural status was classified based on the ZCTA’s rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. Findings Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993–1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival. Conclusions In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents.

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Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA

Khosla

Zachary

2016

AIDS Care

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HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust.

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Is anybody out there? Integrating HIV services in rural regions

Cited by 9 publications

References 7 publications

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

Rural AIDS Diagnoses in Florida: Changing Demographics and Factors Associated With Survival

Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA

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