Win-win solutions: A policy-based intervention for reducing AIDS-related mortality in rural North Carolina

Issues: Studies show that adherence to anti-retroviral therapy (ART) can significantly prolong life in HIV/AIDS patients. However, HIV-positive African American women in rural North Carolina are less likely to have access and adhere to ART and are dying at an accelerated rate compared to other populations. Description: The PRECEDE-PROCEED model is an empirically-based method for intervention formulation and evaluation. By identifying a prioritized health outcome (mortality reduction) and quality of life factor (strengthening family/social networks) for the target population, the model drives the development of an intervention to address behavioral and ecological determinants, including: access to healthcare and daily needs, physical and financial access to ART, negative stigma associated with HIV-positive status, and self-efficacy to adhere to an ART regimen. Lessons Learned: This paper outlines a multi-component intervention guiding the operation of a co-located comprehensive care clinic in Edgecombe County, North Carolina. Policy lobbying is essential to financially sustaining full clinic operation. Specific suggestions are made for addressing inadequate HIV/AIDS funding formularies and federal legislation including the Ryan White Care Act and Senate Bill 311. Recommendations: Although co-located care facilities have proven successful in treating HIV/AIDS in rural and urban settings, they can require extensive coordination and a large, sustained budget. Nevertheless, the later, more debilitating stages of AIDS necessitate more expensive treatments, thereby justifying the implied policy changes in HIV/AIDS funding formularies. The benefits of implementing this intervention outweigh the costs: Currently underserved individuals in the target population would receive affordable, timely, and sustained HIV/AIDS care and treatment.