Benefits and Barriers to Decentralized HIV Care for Patients in Underserved Communities

Brian Wood, M.D., at IDWeek 2016 in New Orleans, Louisiana (Credit: Olivia G. Ford/TheBodyPRO.com)

An Interview With Brian Wood, M.D.

By Olivia G. Ford

From TheBodyPRO.com

 

October 30, 2016

____________________________________________________________________________________ 

People living with HIV who must travel long distances to their HIV care providers -- or are out of care due to a shortage of local providers -- are highly vulnerable to disease progression, which increases the likelihood of transmitting HIV. Residents of Washington state face time, transportation and other barriers to accessing care in urban areas of the state, leaving Seattle's rural neighbors largely underserved.

 

To address this problem, beginning in 2007, a unique partnership was developed between an academic medical center, the Washington State Department of Health and individual community health care centers. At IDWeek 2016 in New Orleans, I spoke with Brian Wood, M.D., a faculty member of the division of allergy and infectious diseases at the University of Washington, who presented this model for offering HIV care in rural areas.

Thanks so much for speaking with me, Dr. Wood. Tell us what this partnership was meant to accomplish.

What we found in Washington state is that, in the rural parts of the state, outside of Seattle and the urban areas, many patients who were being asked to travel all the way to the academic medical center in Seattle simply weren't coming and weren't engaged in care.

This initiative, which was led by one of my mentors, Dr. Bob Harrington, involved partnering with our state Department of Health and several community partners to launch satellite clinics in the less populated parts of Western Washington. The idea was that we could reduce barriers and help patients engage in care by having a provider go out to that site, as opposed to asking the patient to come all the way into Seattle.

We've now launched four of these satellite clinics in various sites in Western Washington. The model involves an HIV provider from the university going out to that clinical site, to the clinic of a community partner or to the public health department, and then setting up shop and offering a full day of HIV clinic to patients from that part of the state.

What have been the results in the communities being served, in terms of uptake as well as clinical outcomes?

What we've found is that the patients have been incredibly appreciative of this model. Our number of enrollees in each clinic and our number of visits continue to go up every year. We've now managed to engage in these clinics almost 700 patients -- almost 6,000 visits -- including a number of patients who previously were totally not engaged in care and a number who were previously being asked to drive over 50 miles to receive care.

We've looked at our viral load suppression rates as a snapshot in 2015. We've seen over time, after launching these satellite clinics, the rates of viral suppression increase for those who are engaged in the satellite clinics, compared with patients in the same counties who are not engaged.

Credit Brian Wood, M.D., et al

We looked at some quality of care markers at these satellite clinics and found that they were equivalent to the same clinical care markers at the academic medical center. So, we believe that care out of these satellite clinics is equally as safe and effective and of an equally high quality.

In the poster, we also provide an example of the costs of implementing and maintaining these satellite clinics, with the important point being that funding from our state Department of Health has really been key to the implementation and sustainability of this program.

This is a model of implementing satellite clinics in rural areas that we found to really help to engage patients and to improve local viral suppression rates. The key for us has been partnership with both local partners and our state Department of Health. It's certainly a model that could be expanded to other regions.

Download full poster (Credit Brian Wood, M.D., et al)

Read more articles from The Body Pro, here.