HIV/AIDS in the Rural US Prevalence and Service Availability

Transcription

1 HIV/AIDS i the Rural US Prevalece ad Service Availability Jaice Probst, PhD Medha Iyer, PhD, MD Saudra Glover, PhD Deshia Leohirth, MBA South Carolia Rural Health Research Ceter At the Heart of Public Health Policy

2 HIV/AIDS Basics Huma Immuodeficiecy Virus (HIV) reduces CD4 lymphocyte cells, eeded to combat ifectio u CD4 cout < 200, or selected diagoses, cosidered to be Acquired Immue Deficiecy Sydrome (AIDS) Treatmet protects CD4 cells, immue system At ay level, perso is cotagious ad should be educated re precautios South Carolia Rural Health Research Ceter

3 HIV/AIDS importace Estimated 1.2 millio persos livig with HIV/AIDS (PLWHA) Disproportioately affects miorities, wome, persos livig i the South Could it become a rural disease? u Prevalece i rural America u Service availability i rural America South Carolia Rural Health Research Ceter

4 Prevalece: Data sources Couty data retrieved from state departmet of health web sites, 2008 data F 28 states, 2,012 couties F SCRHRC Study, available at rhr.sph.sc.edu Couty data from 2013 RWJ Couty Rakigs data base, 2009 F Data provided by CDC s Natioal Ceter for HIV/AIDS, Viral Hepatitis, STD, ad TB Prevetio Couty-level data from AIDSVu, 2010 data, also from CDC Limitatios: o-reportig ad data suppressio South Carolia Rural Health Research Ceter

5 Big picture HIV is preset i rural as well as urba couties u High is i relatio to the atioal media rate. HIV tracks closely with poverty ad with miority race/ethicity HIV rates i rural are growig South Carolia Rural Health Research Ceter

6 HIV/AIDS prevalece, 28 states, 2008 Q1 <33.50 Q < Q < Q Rates per 100,000 South Carolia Source: HIV/AIDS i Rural America, rhr.sph.sc.edu Rural Health Research Ceter

7 HIV prevalece, 2009, 43 states, by rurality South Carolia Rural Health Research Ceter Source: SCRHRC aalysis of RWJ Couty Rakigs data,

8 HIV Prevalece, 2010, by rurality South Carolia Rural Health Research Ceter Source: SCRHRC aalysis of AIDSVu data (aidsvu.org)

9 Tiy chages may be harbigers Kasas, Oklahoma 2009 Kasas, Oklahoma 2010 South Carolia Rural Health Research Ceter

10 Rural/urba HIV prevalece, 28 states, 2008 South Carolia Rural Health Research Ceter

11 Rural/urba HIV prevalece, 16 states, 2010 (Data from AidsVu.org) Florida South Carolia Delaware New York Louisiaa Massachusetts North Carolia Hawaii Marylad Alabama Coecticut Arizoa Pesylvaia New Hampshire Maie Vermot South Carolia Rural Health Research Ceter HIV+ per 100,000 Rural Urba Source: AIDSVu. Restricted to 16 states with complete couty data

12 HIV treatmet Chroic treatmet with atiretroviral medicatios costs about $10,000 - $12,000 per year Nearly half of PLWHA receive care through the Rya White program u Curret fudig ~ $2.1 billio u 30% of Rya White fudig specifically directed to urba areas (Part A) Rya White providers a proxy for care availability Limitatio: o iformatio VA, other providers South Carolia Rural Health Research Ceter

13 Rya White providers, 50 states, 2008 South Carolia Rural Health Research Ceter

14 Why worry? Distace may matter Norto KS to Wichita KS: u 268 miles Guymo OK to Oklahoma City: u 263 miles South Carolia Rural Health Research Ceter

15 Coclusios Few Rya White providers i rural couties u Research is eeded to assess effects of local service availability o remaiig i care, health outcomes Research is eeded to assess use of other providers i rural areas u CHC s, health departmets may help, but: u HIV is a complex coditio requirig specialized kowledge u VA addresses o-specialist quality of care through telemedicie ad tele-educatio South Carolia Rural Health Research Ceter