NotesFAQContact Us
Search Tips
Peer reviewed Peer reviewed
Direct linkDirect link
ERIC Number: EJ878674
Record Type: Journal
Publication Date: 2010
Pages: 7
Abstractor: As Provided
Reference Count: 23
ISSN: ISSN-0890-765X
The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics
Grace, Christopher; Kutzko, Deborah; Alston, W. Kemper; Ramundo, Mary; Polish, Louis; Osler, Turner
Journal of Rural Health, v26 n2 p113-119 Spr 2010
Context: Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers. Purpose: To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic. Methods: This was a retrospective cohort study. Findings: Over an 11-year period 363 new patients received care, including 223 in the urban clinic and 140 in the rural clinics. Patients in the 2 cohorts were demographically similar and had similar initial CD4 counts and viral loads. There was no difference between the urban and rural clinic patients receiving "Pneumocystis carinii" prophylaxis (83.5% vs 86%, P = 0.38) or antiretroviral therapy (96.8% vs 97.5%, P = 0.79). Both rural and urban cohorts had similar decreases in median viral load from 1996 to 2006 (3,876 copies/mL to less than 50 copies/mL vs 8,331 copies/mL to less than 50 copies/mL) and change in percent of patients suppressed to less than 400 copies/mL (21.4%-69.3% vs 16%-71.4%, P = 0.11). Rural and urban cohorts had similar increases in median CD4 counts (275mm[superscript 3]-350mm[superscript 3] vs 182 cells/mm[superscript 3]-379mm[superscript 3]). A repeated measures regression analysis showed that neither fall in viral load (P = 0.91) nor rise in CD4 count (P = 0.64) were associated with urban versus rural site of care. Survival times, using a Cox proportional hazards model, were similar for urban and rural patients (hazard ratio for urban = 0.80 [95%CI, 0.39-1.61; P = 0.53]). Conclusions: This urban outreach model provides similar quality of care to persons receiving care in rural areas of Vermont as compared to those receiving care in the urban center.
Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail:; Web site:
Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A
Identifiers - Location: Vermont