Presentation Abstract

Access and Barriers to Care in Rural Vermont. C Grace, K Soons, E McGrath, D Kutzko, F Reed, MC Charbonneau. University of Vermont, Burlington.

Issues: The epidemic of HIV/AIDS has spread into rural America. Access to medical care, psychosocial case management, financial assistance and support from community based AIDS Service Organizations (ASO) is limited.

Project: A model for health care delivery in rural Vermont has been developed that will establish three rural HIV specialty clinics that are designed to identify and overcome barriers to care in rural areas. An Initial Visit Questionnaire was used to collect data on client's previous access to care and barriers to care in their community.

Results: The first clinic has been operational for 17 months during which time 35 clients were evaluated. Data has been completed on 32 including 25 men and 7 women. Seventy nine percent (22/28) felt they were infected outside of the state. At the time of HIV diagnosis 47% were living in Vermont. 25% moved to Vermont after HIV diagnosis, though not for HIV related reasons and 28% moved to Vermont for HIV related reasons predominantly for support of their families. Once diagnosed with HIV, 59% sought care immediately, 41% took longer than 1 year and 18% did not seek care for more than 3 years. 78% of the clients had received HIV care prior to the opening of this clinic, most of whom though (18/28, 64%) had to travel 4 hours round trip to a HIV specialty clinic for care. Barriers to care in the community prior to the opening of the clinic included; long travel distances for care (68%), concerns about confidentiality (68%), concern about the quality of care from local Primary Care Provider's (52%), stigmatization by community (44%), limited access to information about HIV services (41%), lack of ASO's in the area (28%), lack of health insurance (31%), fear about being HIV(+) (22%), and lack of experimental therapies (14%). Reasons for coming to the rural clinic included; less travel (62%), to be closer to family (50%), less expense (31%), thought there would be better care (23%), to be closer to their primary care provider (13%), better confidentiality (13%) and better psychosocial support (13%).

Lessons Learned: The majority of PWHIV in this rural community were infected outside the state. Only 28% moved to Vermont for HIV related reasons. Most had received HIV health care but had to travel long distances for it. This clinic model of care identified and removed many of the barriers to care in rural Vermont allowing people with HIV/AIDS to receive comprehensive health care and psychosocial case management in their own community.

Contact: Deborah Kutzko, University Health Center Comprehensive Care Unit 1, So. Prospect St, Burlington, VT 05401 USA.

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