The population with HIV in large cities often receives care in high volume HIV specialty clinics that employ co-located interdisciplinary care teams to provide specialized care. However, 18 percent of the 24,000 veterans being treated for HIV infection in the U.S. live in rural areas and have limited access to this form of healthcare. Seventy two percent of rural veterans with HIV live more than a one hour car ride from their site of care.
As a result, rural veterans with HIV infection seek medical help when their HIV case is in a more advanced stage. They are also less likely to receive the important advances in HIV therapy that are now available and so as a result, they experience higher mortality.
The Veterans Administration’s Iowa City VA Health Care System is doing a research study titled “Improving Access and Outcomes for Rural Veterans with HIV” seeking an innovative delivery model to enable rural veterans with HIV to have care that is not only more accessible but will provide good outcomes.
To start the study, researchers are studying the variations in care for rural versus urban populations suffering from HIV and then they will identify the intermediate outcomes and specific gaps in care affecting rural veterans.
Secondly, researchers will identify barriers to care and obtain stakeholder input on the design of an improved delivery model using qualitative methods. Researchers will use semi-structured interviews with veterans, VA providers, and administrators to identify opportunities to improve care.
The third aim is to develop and evaluate an innovative delivery model that employs existing VA telehealth resources and develop a pilot to test if this innovative telehealth-based delivery model is workable. The goal is to use VA telehealth resources to extend interdisciplinary team-based specialty care.
The knowledge gained from this VA HIV-based research may also help to establish care systems for other chronic conditions that rural veterans experience where they require ongoing specialized care and could also be used to help veterans affected with chronic diseases in urban areas.