Setting: Vermont is a small rural state with a population of 593,000 (1999). There is one small SMA (Burlington area, 150,000) where University of Vermont is located. The service area for the clinics is the entire state.
Model: Four HIV specialty clinics have been established in regional hospitals throughout the state. The main clinic in Burlington is staffed by infectious disease specialists, nurse practitioner, dietician and social worker. Each of the three more rural clinics has a part-time nurse practitioner and social worker. An HIV specialist physician and dietician from the University travel monthly to the three clinics not in the MSA.
Access and Linkage: HIV specialty and primary care, nutritional counseling and case management are provided. Access to medical and surgical subspecialties, ob-gyn and psychiatric care is available. Clinics work in collaboration with regional AIDS service organizations, the Department of Health, regional primary care providers and drug and alcohol programs.
Demographics: There were 278 active patients between 8/99-7/00: 18 % women, 12 % people of color, transmission by MSM (50 %) and IDU (23%), 50% unemployed and 72% < 300 % of poverty, 28% with AIDS, 32% co-infected with HCV.
Outcomes: The development of rural clinics reduced travel time for care for 80 % of patients. Over 46 months CD4 counts improved a mean of 58 cells and increased in 55%. Viral loads fell in 61 % with a mean log drop of 0.9. 90% and 75% of eligible patients are on PCP and MAC prophylaxis.
Learning Objectives: 1. Describe how rural HIV clinical services are provided through the Comprehensive Care Clinics in Vermont. 2. Describe how rural HIV clinical sites link with specialty and community-based services. 3. Understand how quality improvement is monitored in the Vermont HIV clinical program.
Keywords: HIV/AIDS, Rural Health Care Delivery System
Awards: - WinnerPresenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.