SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 12 (June 12, 1998)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

The University of Vermont & State Agricultural College's Rural HIV Service Delivery project has implemented three state-of-the-art rural HIV specialty clinics throughout the state. The main goal of the project is to reduce barriers and facilitate access for persons with HIV/AIDS in isolated and sparsely populated areas, who would otherwise have to travel several hours over mountain roads to access HIV specialty medical care.

What is the face of HIV/AIDS in Vermont? Between August 1994 and December 1997, 99 patients were seen at the project's clinics. The average age of the patients is 39 years old, 80 percent are male and 20 percent are female. Of those people not employed, the majority (62 percent) are on disability, 12 percent receive support from family and friends, 15. percent are on welfare, and 11 percent receive no support. With regard to medical insurance, 52 percent have Medicaid/Medicare, 19 percent have private insurance, 18 percent have no insurance, and 11 percent have some other form of insurance. When first presenting at the clinic, 32 percent have CD4 counts between 200-500, 45 percent have less than 200, and 23 percent have more than 500. Forty-six percent were diagnosed with AIDS at their first visit to the clinic, 14 percent had opportunistic infections, and 2 percent had tumors.

Because almost half of the patients seen by this project have an AIDS diagnosis by the time they receive care, it is extremely important to ensure greater accessibility to high quality care. Information was collected at initial intake from 67 patients on barriers to receiving health care prior to receiving services at the new clinics. Patients felt that the amount of travel time was a major barrier (55 percent). In addition, confidentiality (55 percent), the stigma attached to HIV/AIDS in the local community (51 percent) and the quality of care given by primary care physicians with regard to HIV/AIDS (45 percent) have been perceived as concerns as well.

The arrival of the Comprehensive Care Clinics (CCC) had a major impact on reducing travel time to healthcare for HIV/AIDS patients in rural Vermont. An HIV/AIDS infectious disease specialist, nurse practitioners trained in HIV care, a hospital social worker, and regional AIDS Service Organization representatives staff the clinics. Prior to the opening of the satellite clinics, the majority of patients had to travel more than one hour to a clinic site. After the CCC opened this barrier was dramatically reduced, now with the majority of patients traveling less than thirty minutes to receive care. In addition to improving access to care, the Vermont project is also able to improve the quality of care in these communities by providing training and expertise to local health care providers. The project continues to look at ways in which the Comprehensive Care Clinics will improve access to and quality of HIV care.

For further information contact Christopher J. Grace, M.D., Project Director, Associate Professor, University of Vermont & State Agricultural College, Medical Center Hospital, Brown 338, Burlington, VT, 05401, 802.656.4836, 802.656.5322 (fax), e-mail: christopher.grace@vtmednet.org.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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