Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system

Michael Ohl; Brian Lund; Pamela S Belperio; Matthew Bidwell Goetz; David Rimland; Kelly Richardson; Amy Justice; Eli Perencevich; Mary Vaughan-Sarrazin

doi:10.1007/s10461-011-0107-8

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Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system

Journal article

Peer reviewed

Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system

Michael Ohl, Brian Lund, Pamela S Belperio, Matthew Bidwell Goetz, David Rimland, Kelly Richardson, Amy Justice, Eli Perencevich and Mary Vaughan-Sarrazin

AIDS and behavior, Vol.17(1), pp.250-259

01/2013

DOI: 10.1007/s10461-011-0107-8

PMCID: PMC5009625

PMID: 22205324

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Abstract

Rural persons with HIV face barriers to care that may influence adoption of advances in therapy. We performed a retrospective cohort study to determine rural-urban variation in adoption of raltegravir-the first HIV integrase inhibitor-in national Veterans Affairs (VA) healthcare. There were 1,222 veterans with clinical indication for raltegravir therapy at time of its FDA approval in October 2007, of whom 223 (19.1%) resided in rural areas. Urban persons were more likely than rural to initiate raltegravir within 180 days (17.3% vs. 11.2%, P = 0.02) and 360 days (27.5% vs. 19.7%, P = 0.02), but this gap narrowed slightly at 720 days (36.3% vs. 31.8%, P = 0.19). In multivariable analysis adjusting for patient characteristics, urban residence predicted raltegravir adoption within 180 days (odds ratio 1.72, 95% CI 1.09-2.70) and 360 days (OR 1.63, 95% CI 1.13-2.34), but not 720 days (OR 1.26, 95% CI 0.84-1.87). Efforts are needed to reduce geographic variation in adoption of advances in HIV therapy.

Multivariate Analysis

Residence Characteristics

United States

Humans

Middle Aged

Child, Preschool

Infant

Male

Urban Population

Viral Load

Young Adult

Rural Population

Adult

Female

Surveys and Questionnaires

Retrospective Studies

Odds Ratio

Raltegravir Potassium

Child

Infant, Newborn

Health Services Accessibility - statistics & numerical data

HIV Infections - virology

Pyrrolidinones - therapeutic use

CD4 Lymphocyte Count

Rural Health Services - organization & administration

Patient Acceptance of Health Care

Adolescent

HIV Integrase Inhibitors - therapeutic use

Diffusion of Innovation

Healthcare Disparities

HIV Infections - drug therapy

United States Department of Veterans Affairs

Aged

Veterans - statistics & numerical data

Delivery of Health Care - trends

Details

Title: Subtitle: Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system
Creators: Michael Ohl - VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA. michael.ohl@va.gov
Brian Lund
Pamela S Belperio
Matthew Bidwell Goetz
David Rimland
Kelly Richardson
Amy Justice
Eli Perencevich
Mary Vaughan-Sarrazin
Resource Type: Journal article
Publication Details: AIDS and behavior, Vol.17(1), pp.250-259
DOI: 10.1007/s10461-011-0107-8
PMID: 22205324
PMCID: PMC5009625
NLM abbreviation: AIDS Behav
ISSN: 1090-7165
eISSN: 1573-3254
Publisher: United States
Grant note: U24 AA020794 / NIAAA NIH HHS U01 AA020790 / NIAAA NIH HHS U10 AA013566 / NIAAA NIH HHS
Language: English
Date published: 01/2013
Academic Unit: Psychiatry; Health Management and Policy; Epidemiology; Internal Medicine
Record Identifier: 9983779294802771

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